Acute Myocardial Dysfunction in Severe Sepsis

220 Overall mortality was 19.7%. AUCs for initial lactate, relative lactate clearance, and absolute lactate clearance were 0.70, 0.69, and 0.58, respectively. Lactate normalization best predicted survival (odds ratio [OR] 6.1, 95% confidence interval [CI] 2.2–21), followed by lactate clearance of 50% (OR 4.3, 95% CI 1.8–10.3), initial lactate of < 2 mmol/L (OR 3.4, 95% CI 1.5–7.8), and initial lactate < 4 mmol/L (OR 2.3, 95% CI 1.3–4.3), with lactate clearance of 10% not reaching significance (OR 2.3, 95% CI 0.96–5.6). Conclusion: In ED sepsis patients undergoing early quantitative resuscitation, normalization of serum lactate during resuscitation was strongly associated with survival more than any absolute value or absolute/relative change in lactate. Further studies should address whether strategies targeting lactate normalization leads to improved outcomes. NOTE: This abstract was previously published in a supplement for the International Symposium of Intensive Care and Emergency Medicine, Brussels, March 2011. , ACUTE MYOCARDIAL DYSFUNCTION IN SEVERE SEPSIS. E. Guerrini, S. Bianchi, C. Donnini, F. Innocenti, R. Pini, Critical Care Medicine and Surgery, Osservazione Breve Intensiva, Florence, ITALY. Objective: The development of hemodynamic instability plays a key role in the progression from sepsis to severe sepsis and septic shock. The aim of this study was to identify the prevalence of acute myocardial dysfunction (AMD) and clinical predictors of heart involvement in septic patients. Methods: From June 2008 to April 2011, we performed echocardiograms on 65 patients with severe sepsis or septic shock without known heart disease within 5 days of admission in our High Dependency Unit. Myocardial involvement was defined as global left (LV ejection fraction < 50%) or right ventricular (RV tricuspid annular plane systolic excursion < 18 mm) systolic dysfunction. Patients were divided into two groups according to the presence (D+) or absence (D ) of AMD. Results: The study population included 35 men and 30 women with mean age of 74 6 14 years. Within 28 days, 14 (23%) patients died, LVAMD was found in 26 patients (40%) and RV-AMD in 3. Comparing patients with and without AMD, index of sepsis severity like the Sequential Organ Failure Assessment score after the first 24 h, lactate level on admission and lactate clearance were similar. Hemodynamic profile, in terms of mean arterial pressure and highest heart rate worst value, in the first 48 h did not show any difference. Hemodynamic support with vasopressors had been used in 22 patients (33%) and showed a correlation with 28 days mortality (46% vs. 10%, p = 0.001), but not with AMD. Troponin I peak was no different in the two groups, whereas pro-BNP was measured on admission and after 24 h, and the maximum values were significantly higher in patients with AMD. Procalcitonin values in turn showed a similar trend, both measured after 24 h and as peak value (Table 1). Mortality rates were similar in the two groups (19% D vs. 20% D+, p = NS), whereas patients with AMD showed a higher degree of disability expressed as a worsening in activities-of-daily-living scale (0% vs. 36.4%, p = 0.011). Conclusions: AMD was observed in about half of severe sepsis and septic shock patients; it was related to a higher degree of disability at hospital discharge. Heart involvement was not linked to sepsis severity and was not

MEMC VI Abstracts predictable by hemodynamic parameters, but biomarkers such as procalcitonin and pro-BNP are useful to detect myocardial dysfunction in severe stages of septic disease. , NEW SYNTHETIC CANNABINOIDS INTOXICATIONS IN ITALY: CLINICAL IDENTIFICATION AND ANALYTICAL CONFIRMATION OF CASES. C.A. Locatelli, D. Lonati, A. Giampreti, V. Petrolini, S. Vecchio, C. Rognoni, S. Bigi, E. Buscaglia, M. Mazzoleni, L. Manzo, Poison Control Centre and National Toxicology Information Centre, Toxicology Unit, IRCCS Maugeri Foundation and University of Pavia, Pavia, ITALY; P. Papa, A. Valli, Laboratory of Analytical Toxicology, Clinical Chemistry Service, IRCCS Policlinico San Matteo Foundation, Pavia, ITALY; C. Rimondo, Addiction Department, ULSS 20, Verona, ITALY; G. Serpelloni, Department for Antidrug Policies - Presidency of the Council of Ministers, Rome, Rome, ITALY. Objective: At the end of 2008, the Department for Antidrug Policies (DPA) in Italy activated the National Early Warning System for Drugs (NEWS), with the Pavia Poison Centre (PPC) identified as the Coordinating Centre for clinico-toxicological aspects. Methods: We report cases in which synthetic cannabinoids use was related to specific analytical data and contributed to the endorsement of regulatory actions. Results: During 2008–2010, PPC identified 17 cases of synthetic cannabinoids poisoning, age range 14–55 years. The product names were identified in 15 cases: Spice (1 case), N-Joy (6), Forest Green (3), and Jungle Mystic Incense (5); in the other two cases the products were defined as ‘‘JWH’’ and ‘‘tisane.’’ Clinical manifestations were: tachycardia (13), agitation/anxiety (12), confusion (8), mydriasis (7), hallucinations (5), paresthesia (5), palpitations (4), drowsiness (3), xerostomia (3), coma (2), seizures (2), syncope (2), vertigo (2), tremor (2), hypertonia (1), chest tightness (1), clonus (1), choreoathetosis (1), aphasia (1), nystagmus (1), diplopia (1), hypotension (1), hypertension (1), dyspnea (1), vomiting (1). In 11/17 synthetic cannabinoids were identified in the blood: JWH-122 (5 cases), JWH-122 and JWH-250 (3), JWH-018 (2). Patients received symptomatic treatment and benzodiazepines for neuroexcitatory effects and were discharged asymptomatic within 24 h from exposure; no sequelae were observed. Conclusion: The early PPC identification of ‘‘sentinel’’ cases contributed to identifying health risks related to use of cannabis substitutes. The laboratory confirmation of products and patients (performed in a few hours) permitted us to ascertain the relationship between substances and clinical effects. This is crucial to permit regulatory actions to be finalized for prevention/control. These cases permitted the DPA and Ministry of Health to activate procedures to include these substances in the Italian list of drugs of abuse and illicit psychotropic substances. Acknowledgements: Study carried out with the support of the Italian Department for Antidrug Policies – Presidency of the Council of Ministers. , ACUTE PNEUMONIA AFTER ACCIDENTAL FUEL INGESTION IN ADULTS: A PROSPECTIVE STUDY. V. Petrolini, C.A. Locatelli, D. Lonati, A. Giampreti, S. Vecchio, S. Bigi, C. Rognoni, M. Mazzoleni, E. Buscaglia, L. Manzo, Poison Control Centre and National Toxicology Information