Limits...
Utilization of base deficit and reliability of base deficit as a surrogate for serum lactate in the peri-operative setting.

Chawla LS, Nader A, Nelson T, Govindji T, Wilson R, Szlyk S, Nguyen A, Junker C, Seneff MG - BMC Anesthesiol (2010)

Bottom Line: Over 70% of respondents used BD as an endpoint of resuscitation.Base Deficit Study: 35 patients were enrolled resulting in 88 arterial blood gases with corresponding Lac.Lac can now be measured in the OR in real time.Therefore, if clinicians in the operative setting want to know the Lac, it should be measured directly.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Critical Care Medicine and Anesthesiology George Washington University Medical Center, Washington D,C,, USA. lchawla@mfa.gwu.edu.

ABSTRACT

Background: Base deficit (BD) is commonly used in the operating room (OR) as an endpoint of resuscitation. BD is used as a surrogate marker for the accumulation of lactic acid(Lac). However, the BD can be affected by large amounts of saline.

Methods: We conducted a survey of anesthesiologists regarding the use of BD. We also studied the reliability of BD to determine the presence of hyperlactatemia (HL). Patients undergoing general anesthesia were eligible for enrollment if they were receiving an arterial line as part of their routine care. If an arterial blood gas was drawn by the operative team as part of the routine care, the remainder of the unused blood was also used to measure Lac.

Survey: 73 staff anesthesiologists were surveyed. Over 70% of respondents used BD as an endpoint of resuscitation.Base Deficit Study: 35 patients were enrolled resulting in 88 arterial blood gases with corresponding Lac. Mean age was 61.4 ± 14.3 years, 43% were male. Mean pH was 7.39 ± 0.05, the mean bicarbonate was 23.0 ± 2.3 meq/L, the mean BD 1.34 ± 2.3, and the mean Lac was 1.58 ± 0.71 mmol/L. Mean ASA risk score was 3.16 ± 0.71. ROC area under the curve for base deficit to detect HL was 0.58.

Conclusion: BD can often mislead the clinician as to the actual Lac. Lac can now be measured in the OR in real time. Therefore, if clinicians in the operative setting want to know the Lac, it should be measured directly.

No MeSH data available.


Base Deficit v. Lactate.
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Figure 2: Base Deficit v. Lactate.

Mentions: 73 staff anesthesiologists and anesthesiologists in training were surveyed; 14 (19.2%) from Washington Hospital Center, 24 (32.9%) from the George Washington University Medical Center, and 35 (47.9%) from the University of North Carolina. Of the anesthesiologists surveyed, 37 (50.7%) were still in training, 7(9.6%) had 1-5 years of experience, 6 (8.2%) had 6-10 years of experience, 8(11%) had 11-15 years of experience, and 15(20.5%) had greater than 15 years of experience. Response to Questions 1, 2, 3, and 4 are outlined in Table 1, 2, 3, 4, and Figure 2.


Utilization of base deficit and reliability of base deficit as a surrogate for serum lactate in the peri-operative setting.

Chawla LS, Nader A, Nelson T, Govindji T, Wilson R, Szlyk S, Nguyen A, Junker C, Seneff MG - BMC Anesthesiol (2010)

Base Deficit v. Lactate.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2944305&req=5

Figure 2: Base Deficit v. Lactate.
Mentions: 73 staff anesthesiologists and anesthesiologists in training were surveyed; 14 (19.2%) from Washington Hospital Center, 24 (32.9%) from the George Washington University Medical Center, and 35 (47.9%) from the University of North Carolina. Of the anesthesiologists surveyed, 37 (50.7%) were still in training, 7(9.6%) had 1-5 years of experience, 6 (8.2%) had 6-10 years of experience, 8(11%) had 11-15 years of experience, and 15(20.5%) had greater than 15 years of experience. Response to Questions 1, 2, 3, and 4 are outlined in Table 1, 2, 3, 4, and Figure 2.

Bottom Line: Over 70% of respondents used BD as an endpoint of resuscitation.Base Deficit Study: 35 patients were enrolled resulting in 88 arterial blood gases with corresponding Lac.Lac can now be measured in the OR in real time.Therefore, if clinicians in the operative setting want to know the Lac, it should be measured directly.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Critical Care Medicine and Anesthesiology George Washington University Medical Center, Washington D,C,, USA. lchawla@mfa.gwu.edu.

ABSTRACT

Background: Base deficit (BD) is commonly used in the operating room (OR) as an endpoint of resuscitation. BD is used as a surrogate marker for the accumulation of lactic acid(Lac). However, the BD can be affected by large amounts of saline.

Methods: We conducted a survey of anesthesiologists regarding the use of BD. We also studied the reliability of BD to determine the presence of hyperlactatemia (HL). Patients undergoing general anesthesia were eligible for enrollment if they were receiving an arterial line as part of their routine care. If an arterial blood gas was drawn by the operative team as part of the routine care, the remainder of the unused blood was also used to measure Lac.

Survey: 73 staff anesthesiologists were surveyed. Over 70% of respondents used BD as an endpoint of resuscitation.Base Deficit Study: 35 patients were enrolled resulting in 88 arterial blood gases with corresponding Lac. Mean age was 61.4 ± 14.3 years, 43% were male. Mean pH was 7.39 ± 0.05, the mean bicarbonate was 23.0 ± 2.3 meq/L, the mean BD 1.34 ± 2.3, and the mean Lac was 1.58 ± 0.71 mmol/L. Mean ASA risk score was 3.16 ± 0.71. ROC area under the curve for base deficit to detect HL was 0.58.

Conclusion: BD can often mislead the clinician as to the actual Lac. Lac can now be measured in the OR in real time. Therefore, if clinicians in the operative setting want to know the Lac, it should be measured directly.

No MeSH data available.