Abstract
Objective:Fluid overload is an independent marker for mortality in critically ill patients. Assessment of fluid status and fluid responsiveness is crucial for the management of these patients. In this study, we compared the lactate level, inferior vena cava (IVC) diameter and non-invasive cardiac output (CO) monitoring in prediction of mortality in emergency department.Methods:This was a cross sectional observational study which comprised of 68 patients and was performed in ED of Tabriz University of Medical Sciences, Iran, from Sept 2016 until Sept 2017. IVC diameter was measured before the P-wave on ECG to avoid interference with a-wave and v-wave on the venous pressure curve, and during maximal inspiration and expiration to avoid Valsalva-like maneuvers. An arterial lactate sample was taken from all patients before performing the initial resuscitation. All patients underwent non-invasive CO monitoring by CO2 rebreathing technique. Mortality was noted on day 28.Results:Deceased patients had a significantly low level of IVC diameters, less CO values and more lactate levels. However, based on ROC curve analysis, the prediction accuracy and validity of both CO values obtained by rebreathing CO2 and IVC diameter was poor and the highest accuracy was obtained by lactate level assessment.Conclusion:Initial lactate value is a reliable parameter for prediction of mortality in non-traumatic critically ill patients. IVC diameter changes during spontaneous ventilation and non-invasive CO monitoring does not possess acceptable accuracy for prediction of mortality in these patients.
Highlights
As fluid overload is an independent risk factor for mortality, prediction of fluid responsiveness is an important way for reducing mortality in critically ill patients.[1]
A study showed that a serum lactate level of more than 2.6 mmol/lit predicted 30-day mortality in critically ill patients admitted to emergency department (ED).[4]
Our results showed that 26 patients had lactate levels less than 19.8 and the other had a level more than that
Summary
As fluid overload is an independent risk factor for mortality, prediction of fluid responsiveness is an important way for reducing mortality in critically ill patients.[1] Many markers have been introduced for prediction of fluid responsiveness and mortality in these patients.[2] Elevated lactate has been found to be associated with a higher mortality rate in a vast patient population.[3] A study showed that a serum lactate level of more than 2.6 mmol/lit predicted 30-day mortality in critically ill patients admitted to emergency department (ED).[4]. There are many studies about the predictive value of IVC diameter variation in critically ill patients regarding fluid responsiveness with controversial results.[10,11,12,13,14] Based on the mentioned studies, we wanted to compare the cardiac output values, IVC diameters and lactate levels as predictors of mortality in critically ill non-traumatic patients in ED
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