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.


ROC Area Under the Curve = 0.58.
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Figure 4: ROC Area Under the Curve = 0.58.

Mentions: 35 patients were consented and enrolled into the study. A total of 88 arterial blood gases were drawn with corresponding arterial serum lactate assessed as well. The mean age was 61.4 ± 14.3 years, 43% of the subjects were male. Of the patients, 19 (54.3%) were white, 10 (28.6%) were black, and 6 (17.1%) were from another ethnicity. The types of procedures were varied as shown in Table 5. The mean pH was 7.39 ± 0.05, the mean bicarbonate was 23.0 ± 2.3 meq/L, the mean standard base deficit was 1.34 ± 2.3, and the mean serum lactate was 1.58 ± 0.71 mmol/L. Of the 35 patients, six had and ASA risk score was 2 (n = 6), 3(n = 16), and 4(n = 11). For two subjects, no ASA risk score was recorded. As expected, base deficit correlated with pH and serum lactate (r = 0.40, p < 0.001, r = 0.27, p = 0.01, respectively) (Table 6). The correlation of BD versus serum lactate is shown in Figure 2. Figure 3 shows the difference of lactate and BD plotted against the amount of intravenous fluids given at the time of the measurement. The ROC area under the curve for base deficit to detect hyperlactatemia was 0.58 (Figure 4).


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)

ROC Area Under the Curve = 0.58.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: ROC Area Under the Curve = 0.58.
Mentions: 35 patients were consented and enrolled into the study. A total of 88 arterial blood gases were drawn with corresponding arterial serum lactate assessed as well. The mean age was 61.4 ± 14.3 years, 43% of the subjects were male. Of the patients, 19 (54.3%) were white, 10 (28.6%) were black, and 6 (17.1%) were from another ethnicity. The types of procedures were varied as shown in Table 5. The mean pH was 7.39 ± 0.05, the mean bicarbonate was 23.0 ± 2.3 meq/L, the mean standard base deficit was 1.34 ± 2.3, and the mean serum lactate was 1.58 ± 0.71 mmol/L. Of the 35 patients, six had and ASA risk score was 2 (n = 6), 3(n = 16), and 4(n = 11). For two subjects, no ASA risk score was recorded. As expected, base deficit correlated with pH and serum lactate (r = 0.40, p < 0.001, r = 0.27, p = 0.01, respectively) (Table 6). The correlation of BD versus serum lactate is shown in Figure 2. Figure 3 shows the difference of lactate and BD plotted against the amount of intravenous fluids given at the time of the measurement. The ROC area under the curve for base deficit to detect hyperlactatemia was 0.58 (Figure 4).

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.