Blood Lactate Levels Research Articles

Lactate levels in the brain and blood of schizophrenia patients: A systematic review and meta-analysis

BackgroundThe pathophysiological mechanisms of schizophrenia are still unclear. Converging evidence suggests that energy metabolism abnormalities are involved in schizophrenia, and support its role in the pathophysiology of this disease. Lactate plays an important role in energy metabolism. Many studies have reported changes in the levels of lactate in the brain and serum of schizophrenia patients; however, the results from these studies are not consistent. To overcome this limitation, the goal of the present meta-analysis is to analyze the changes in lactate levels in the brain and blood of schizophrenia patients. MethodsFor this systematic review and meta-analysis, we performed a thorough search of relevant literature in the English language, using the MEDLINE, Cochrane, and Embase databases. ResultsIn the present meta-analysis, 20 studies were scrutinized, including 13 studies on brain lactate levels, which involved 322 schizophrenia patients and 324 healthy individuals as controls. 7 studies on blood lactate levels, involving 234 schizophrenia patients and 238 healthy individuals, were also included. Brain lactate levels were elevated in schizophrenia patients, both in vivo and in post-mortem studies. Nevertheless, blood lactate levels in schizophrenia patients have revealed no statistically significant difference, as compared with control individuals. ConclusionsIn comparison with healthy individuals, schizophrenia patients had higher lactate levels in the brain, rather than in the blood. These findings suggest independent regulatory mechanisms of lactate levels in the brain and peripheral tissues. Abnormal lactate metabolism in the brain may be an important pathological mechanism in schizophrenia.

Management of Critically Ill Patients with Severe Diabetic Ketoacidosis and Acute Renal Failure: A Case Report

Background: Diabetic ketoacidosis (DKA) is one of the hyperglycemic crises related to diabetes. The main problem in DKA is ketogenesis, a metabolic process that increases the production and decreases the utilization of ketones. DKA is characterized by a biochemical triad such as hyperglycemia, ketonemia, and high anion gap metabolic acidosis. Management of DKA needs to be carried out appropriately and immediately because it may lead to diabetic coma and death.
 Case presentation: A 38-year-old woman had decreased consciousness due to metabolic encephalopathy as a complication of severe DKA. The metabolic derangement shows an overlapping high anion gap metabolic acidosis and non-anion gap metabolic acidosis. This case is complicated by acute renal failure. The patient also had been in a hypovolemic state, causing pre-renal acute kidney injury. We treat the patient using a balanced solution to correct hypovolemia. Sonography of the vena cava and blood lactate levels are used to guide fluid resuscitation. We intubate and control the patient's breathing to reduce the metabolic demand. We titrate the insulin infusion until the ketogenesis process is abolished. Antibiotics are given based on sputum culture.
 Conclusion: Acute renal failure (ARF) is a rare but potentially fatal complication of diabetic ketoacidosis (DKA). Early recognition and aggressive treatment of ARF during DKA may improve the prognosis of these patients.

Liver Enzymes and Blood Lactate Profile of Patients Diagnosed with Typhoid Fever in Abuja, Nigeria

Salmonella enterica serotype Typhi antibiotics resistance is on the increase and this frustrates efforts at treatment. Persistence of drug-resistant typhoid fever leads to higher mortality rate because treatment is evasive. Lactate is a marker of the severity of stress response in illnesses and liver function enzymes are indicative of the health of the liver. This study intended to identify the effect of drug resistant typhoid fever infection on liver enzymes and blood lactate levels of patients diagnosed with typhoid fever. Fifty subjects were recruited, forty-five were positive for Widal test and further subjected to stool culture examination for the identification of Salmonella Typhi. All patient’s blood were analysed for lactate, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP). Salmonella Typhi were identified in eight out of forty-five Widal positive test patients. The eight positive Salmonella Typhi isolates showed resistance to the Amoxicillin (30 mcg), Tetracycline(30 mcg), Cotrimoxazole (25 mcg), Ceftriazone (30 mcg), Levofloxacin (5 mcg), Gentamicin (30 mcg) and Netillin (30 mcg) but showed susceptibility to ofloxacin (5 mcg). ALP (158.1±8.32 IU/L), AST(55.1±6.78 U/L), ALT (65.2 ±4.96U/L) and blood lactate (10.5±2.4 mmol/L), were elevated in all drug resistant patients when compared to reference standard ALT (7-56 U/L), AST (10-40 U/L), ALP (20-120IU/L), lactate (0.8-2.2 mmol/L). ALT, AST and ALP enzyme levels increased with increasing number of resistances to antibiotics. Untreated typhoid fever infection exerts metabolic toll on liver functions.

Tolerability of an Individualized Physical Rehabilitation Program in Patients Dependent on Inotropic Support With End-Stage Chronic Heart Failure

Aim To assess the tolerability of an individualized physical rehabilitation program (PRP) in inotrope-dependent patients with end-stage chronic heart failure (CHF).Material and methods This prospective randomized study included 120 men aged 18-65 years with left ventricular ejection fraction ≤30 % and blood pressure ≥90 / 60 mm Hg. Patients who have received dobutamine or dopamine for ≥2 weeks were randomized into two groups: group 1, 40 patients who participated in the PRP and group 2, 40 patients who did not participate in the PRP. Group 3 included 40 patients without inotropic support who participated in the PRP.Results Patients of groups 1 and 3 attended >80 % of the scheduled classes without developing life-threatening adverse events (AEs) associated with exercise (E). After 6 months of the study, the exercising patients achieved a comparable (average) E intensity: 44 [35; 50]% and 45 [40;52]% of heart rate reserve and Borg scale scores 14 [12; 14] and 13 [11; 14] in groups 1 and 3, respectively (p>0.05). Initially, after 3 and 6 months at the peak of physical activity in groups 1 and 3, there was no decrease in arterial blood oxygen saturation according to pulse oximetry (SpO2) <93 %. At baseline, lactate levels in central venous blood at rest were normal in all groups. After 6 months, the lactate concentration was 1.1 mmol / l in group 1, 2.3 mmol / l in group 2, and 1.4 mmol / l in group 3 (р1-2=0.005; p2-3=0.008, respectively). At the E peak at baseline, after 3 and 6 months, comparable increases in lactate not exceeding 3 mmol / l were detected in groups 1 and 3.Conclusion The study allowed assessment of the tolerability of individualized PRP performed at the aerobic level of energy supply, in inotropic-dependent patients with CHF. Individualized 6-month PRP in inotropic-dependent patients with end-stage CHF, provided safety criteria are met, is well tolerated and does not increase the number of AEs associated with CHF and physical rehabilitation (PR). Continued inotropic support with dopamine or dobutamine should not be considered as a contraindication to PR in patients with CHF in the absence of E intolerance or life-threatening AEs.

The lactate response to a second bout of exercise is not reduced in a concurrent lower-limb exercise program

We aimed to evaluate the blood lactate level in response to two bouts of exercise. First, we hypothesized that blood lactate elevation in response to moderate-intensity aerobic exercise (MIAE) would be lower at the end of the second bout of MIAE than the first bout of MIAE. In this context, we also hypothesized that lactate accumulation at the end of resistance exercise (RE) would be reduced if MIAE is performed before RE (i.e., concurrent exercise; CE). If so, we hypothesized that the order of the CE (i.e., RE + MIAE vs. MIAE + RE) influences blood lactate kinetics. To test the hypotheses, forty-three healthy men participated in three studies. In study 1, 20 men (age 21 ± 2 years) performed two bouts of a 20-min MIAE separated by a 20-min rest interval. In study 2, 11 men (age 22 ± 1 years) performed RE only and CE (MIAE + RE; ARCE) with a 20-min rest interval in a crossover design. In study 3, 12 men (age 21 ± 2 years) performed both CEs, which were ARCE and RE + MIAE (RACE), with a 20-min rest interval in a crossover design. We measured blood lactate before and at the end of each exercise session. In study 1, the blood lactate response to the second bout of MIAE was lower than that of the first bout (P < 0.001, r = 0.68). However, the blood lactate response to the ARCE trial was not lower than the response to the RE trial in study 2 (P = 0.475, r = 0.22). The results of study 3 showed that the RACE and ARCE trials induced a similar lactate response (MIAE P = 0.423, r = 0.28; RE P = 0.766, d = 0.03). These observations indicate that whereas lactate accumulation might be diminished by a second bout of MIAE, a different type of exercise (i.e., aerobic/resistance) did not result in a diminished lactate accumulation in response to a second bout of exercise.

Blood Lactate and Heart Rate Responses Between Active and Passive Recovery Modes Over a 15-Minute Recovery Period in Female Dancers After Kathak Dance.

Introduction: Dance is physically demanding and results in blood lactate (BL) accumulation and elevated Heart Rate (HR). Researchers recommend using either Active Recovery (AR; eg, low-to-moderate intensity-exercise) or Passive Recovery (PR; eg, complete rest) modes after activity. We compared BL and HR responses between AR or PR over a 15-minute recovery period following a Kathak dance. Methods: Twelve female dancers (31.0 ± 6.0 years; 161.5 ± 4.9 cm; 55.5 ± 5.8 kg) performed 2 dance testing sessions (Day 1 = AR, Day 2 = PR) 48 hours apart. Each session started with a 10-minute warm up followed by dancers performing four 2-minute stages of Kathak dance, with three 1-minute periods between stages where we recorded HR and their Rate of Perceived Exertion (RPE:scale = 6-20) to match the intensity of both sessions. Post-dance, we recorded dancers' BL and HR at 1, 3, 5, 10, and 15 minutes while they recovered via AR or PR. Separate 2(mode) × (time) Repeated-Measures-ANOVA followed by simple-main-effects testing and adjusted Bonferroni-pairwise-comparisons examined differences in BL and HR responses across modes and time(α = .05). Results: Dancers' HR and RPE were similar across sessions. No mode × time interaction existed in BL (F4,8 = 3.6, P = .06). BL levels were similar across modes (F1,2 = 0.5, P = .5). BL levels reduced over time (F4,8 = 6.0, P = .02), but Bonferroni-comparisons did not reveal any pairwise differences. In HR a significant mode*time interaction (F4,36 = 11.0, P = .01, η2 = .55) was observed. Both Active and Passive recovery modes achieved absolute HR levels by 15 minutes, with PR mode stabilizing within 5 minutes. Conclusions: Over a 15-minute recovery period after Kathak dance, dancers' BL and HR responses were similar across time in both AR and PR, with HR being higher in AR. Dancers' HR remained similar from 1 to 3 minute post dance recovery and then dropped over time. Thus, dancers can rest up to 3 minutes and still maintain the same elevated HR. Overall, dancers can choose either AR or PR as their recovery mode based on their individual preferences.

Diving into Recovery. The Effects of Different Post-Competition Protocols for Enhancing Physio-Psychological Parameters in National Level Youth Swimmers.

The purpose of this study was to elucidate whether a specific approach regarding active swimming recovery could better promote psycho-physiological recovery right after competing in a high-level swimming race. To achieve this, we recruited 50 national level youth swimmers, randomly and equally assigning them to two groups, named "experimental" and "coach prescribed". Each group performed a specific post-competition recovery protocol, consisting of different swimming paces, rest times, self-management of the exercises. We gathered data about blood lactate (BL), heart rate (HR), and rate of perceived exertion (RPE) at two different moments, the first moment right after the swimming competition (named post-competition phase), the second moment right after swimming the respective recovery protocol assigned (named post-recovery phase). A mixed MANOVA with Tukey HSD post-hoc analysis revealed no significant differences between the experimental and coach-prescribed groups in BL, HR, and RPE at the post-competition phase. At the post-recovery phase, however, the experimental group presented lower BL levels than the coach-prescribed group (2.40 ± 1.18 vs. 4.29 ± 2.07 mmol/L, p < 0.05). Finally, we found no interaction of swimming race ranking on recovery capacities. We conclude that for immediate improvement of BL in a wide range of high-level swimmers, an efficient recovery protocol should consist of several paces, high volumes, fixed and short rest times, whereas the widely popular self-managed, lower intensity approach does not seem as equally effective. Our study advances the development of novel recommendations for optimizing immediate fatigue management in competitive swimming.

Cognitive Improvement through Breathing Exercises in Post-Stroke Respiratory Sarcopenia: A Review

PURPOSE: The first purpose of this study is to investigate the relationship between Post-Stroke Respiratory Sarcopenia (PSRS) and Cognitive Impairment (CI) through Breathing Exercise (BE) as a respiratory rehabilitation after stroke (ST). The second purpose is to introduce a pilot study design set to investigate and compare the acute effects of each BE to develop a BE protocol for further studies.METHODS: Pubmed, Scopus, Web of Science and Google Scholar search engines were used to identify the definition and mechanism of ST, CI and respiratory sarcopenia (RS), and to find cases of application of BE in such conditions.RESULTS: Review; BEs that improve ST, RS, and CI symptoms are Box Breathing (Tactical Breathing), Fast-Breathing, Slow-paced Breathing, Inspiratory Diaphragmatic Breathing+Expiratory Pursed-lip Breathing Exercise. However, the effect is still unclear as post-stroke patients undergo multiple medical treatments other than BE. Pilot Study Prospective results; Inspiratory Diaphragmatic Breathing+Expiratory Pursed-lip Breathing Exercise, Slow-paced Breathing, Box Breathing (Tactical Breathing) and Fast-Breathing will be performed by 40 healthy college students through a randomized controlled trial for 4 weeks. Respiratory functions, exercise intensity, active oxygen level, blood lactate level, cerebral oxygen saturation and cognitive function will be measured pre- and post-intervention along with acute and 2 week mid-intervention. BEs are expected to improve respiratory function, cognitive performance and energy levels while reducing HR, BP, and stress. However, individual response to BE may vary according to health, physical fitness and life styles. All BE will be conducted in an evenly controlled and supervised environment for accurate data collection.CONCLUSIONS: Further study will be done to develop an appropriate BE protocol for PSRS patients per this review. Follow-up studies may also use this review as a reference for the application of BEs in PSRS patients with CI.

Dose–response effect of pre-exercise carbohydrates under muscle glycogen unavailability: Insights from McArdle disease

BackgroundThis study aimed to determine the effect of different carbohydrate (CHO) doses on exercise capacity in patients with McArdle disease—the paradigm of “exercise intolerance”, characterized by complete muscle glycogen unavailability—and to determine whether higher exogenous glucose levels affect metabolic responses at the McArdle muscle cell (in vitro) level. MethodsPatients with McArdle disease (n = 8) and healthy controls (n = 9) underwent a 12-min submaximal cycling constant-load bout followed by a maximal ramp test 15 min after ingesting a non-caloric placebo. In a randomized, double-blinded, cross-over design, patients repeated the tests after consuming either 75 g or 150 g of CHO (glucose:fructose = 2:1). Cardiorespiratory, biochemical, perceptual, and electromyographic (EMG) variables were assessed. Additionally, glucose uptake and lactate appearance were studied in vitro in wild-type and McArdle mouse myotubes cultured with increasing glucose concentrations (0.35, 1.00, 4.50, and 10.00 g/L). ResultsCompared with controls, patients showed the “classical” second-wind phenomenon (after prior disproportionate tachycardia, myalgia, and excess electromyographic activity during submaximal exercise, all p < 0.05) and an impaired endurance exercise capacity (–51% ventilatory threshold and –55% peak power output, both p < 0.001). Regardless of the CHO dose (p < 0.05 for both doses compared with the placebo), CHO intake increased blood glucose and lactate levels, decreased fat oxidation rates, and attenuated the second wind in the patients. However, only the higher dose increased ventilatory threshold (+27%, p = 0.010) and peak power output (+18%, p = 0.007). In vitro analyses revealed no differences in lactate levels across glucose concentrations in wild-type myotubes, whereas a dose–response effect was observed in McArdle myotubes. ConclusionCHO intake exerts beneficial effects on exercise capacity in McArdle disease, a condition associated with total muscle glycogen unavailability. Some of these benefits are dose dependent.

Hyperlactatemia in patients undergoing pulmonary endarterectomy with deep hypothermic circulatory arrest: Risk factors and its effects on the outcome.

To determine the risk factors of hyperlactatemia in pulmonary endarterectomy (PEA) surgery and assess whether elevated blood lactate levels are associated with adverse outcomes. In this retrospective observational study, a total of 111 consecutive patients who underwent PEA for chronic thromboembolic pulmonary hypertension at the XXX Hospital between December 2016 and January 2022 were included. We retrospectively evaluated arterial blood samples analyzed intraoperatively. The pre- and intraoperative risk factors for hyperlactatemia and the postoperative outcomes were recorded. Lactate levels gradually increased during surgery. The optimal cut-off lactate level for major postoperative complications, calculated using receiver operating characteristic analysis, was 7.0mmol/L. Deep hypothermic circulatory arrest (DHCA) duration, nadir hematocrit, and preoperative pulmonary vascular resistance were risk factors for lactate levels >7mmol/L. Moreover, the intraoperative peak lactate level during PEA under DHCA was found to be a statistically significant predictor of major complications being associated with longer mechanical ventilation time (r = 0.294; p = .003) and intensive care unit length of stay (r = 0.327; p = .001). Deep hypothermic circulatory arrest duration, nadir hematocrit, and preoperative pulmonary vascular resistance were associated with hyperlactatemia. Increased lactate levels were independent predictors of longer mechanical ventilation time, intensive care unit length of stay, and major complications.

Characteristics of surgical treatment methods for umbilical hernias

Umbilical hernias in surgery are no less relevant than hernias of other localizations. The results of surgical treatment of 317 patients with umbilical hernias are presented. 213 patients (67.2 %) were operated on as an emergency, and 104 (32.8 %) — as planned. Surgical interventions for strangulated hernias were performed in accordance with the principles of emergency abdominal surgery. When examining the patients of the last group, the level of intra-abdominal pressure and blood lactate were taken into account. An informative method for studying the condition of tissues in the area of the hernial orifice is ultrasound. When selecting a method of surgical treatment, its criteria are the size of the hernial orifice, the state of the aponeurosis, and in emergency conditions — the degree of ischemic disorders of the strangulated organ and the severity of intra-abdominal hypertension. A differentiated approach to the choice of hernioplasty for umbilical hernias and the wider use of additional strengthening methods using mesh endoprostheses allow obtaining good results after surgical treatment.

Aminopyridines Restore Ventilation and Reverse Respiratory Acidosis at Late Stages of Botulism in Mice.

Botulinum neurotoxin (BoNT) is a potent protein toxin that causes muscle paralysis and death by asphyxiation. Treatments for symptomatic botulism are intubation and supportive care until respiratory function recovers. Aminopyridines have recently emerged as potential treatments for botulism. The clinically approved drug 3,4-diaminopyridine (3,4-DAP) rapidly reverses toxic signs of botulism and has antidotal effects when continuously administered in rodent models of lethal botulism. Although the therapeutic effects of 3,4-DAP likely result from the reversal of diaphragm paralysis, the corresponding effects on respiratory physiology are not understood. Here, we combined unrestrained whole-body plethysmography (UWBP) with arterial blood gas measurements to study the effects of 3,4-DAP, and other aminopyridines, on ventilation and respiration at terminal stages of botulism in mice. Treatment with clinically relevant doses of 3,4-DAP restored ventilation in a dose-dependent manner, producing significant improvements in ventilatory parameters within 10 minutes. Concomitant with improved ventilation, 3,4-DAP treatment reversed botulism-induced respiratory acidosis, restoring blood levels of CO2, pH, and lactate to normal physiologic levels. Having established that 3,4-DAP-mediated improvements in ventilation were directly correlated with improved respiration, we used UWBP to quantitatively evaluate nine additional aminopyridines in BoNT/A-intoxicated mice. Multiple aminopyridines were identified with comparable or enhanced therapeutic efficacies compared with 3,4-DAP, including aminopyridines that selectively improved tidal volume versus respiratory rate and vice versa. In addition to contributing to a growing body of evidence supporting the use of aminopyridines to treat clinical botulism, these data lay the groundwork for the development of aminopyridine derivatives with improved pharmacological properties. SIGNIFICANCE STATEMENT: There is a critical need for fast-acting treatments to reverse respiratory paralysis in patients with botulism. This study used unrestrained, whole-body plethysmography and arterial blood gas analysis to show that aminopyridines rapidly restore ventilation and respiration and reverse respiratory acidosis when administered to mice at terminal stages of botulism. In addition to supporting the use of aminopyridines as first-line treatments for botulism symptoms, these data are expected to contribute to the development of new aminopyridine derivatives with improved pharmacological properties.

Pediatric Profound Dengue Shock Syndrome and Use of Point-of-Care Ultrasound During Mechanical Ventilation to Guide Treatment: Single-Center Retrospective Study, 2013-2021.

Profound dengue shock syndrome (DSS) complicated by severe respiratory failure necessitating mechanical ventilation (MV) accounts for high case fatality rates among PICU-admitted patients. A major challenge to management is the assessment of intravascular volume, which can be hampered by severe plasma leakage and the use of MV. Retrospective cohort, from 2013 to 2021. Sixty-seven children with profound DSS supported by MV, some of whom underwent bedside point-of-care ultrasound (POCUS) for assessment and monitoring of hemodynamics and fluid administration. PICU of the tertiary Children's Hospital No. 2 in Vietnam. None. We analyzed data clinical and laboratory data during PICU stay. In particular, during use of MV (i.e., at times 0-, 6-, and 24-hr after commencement) and fluid resuscitation. The primary study outcome was 28-day in-hospital mortality, and the secondary outcomes were associations with changes in hemodynamics, blood lactate, and vasoactive-inotrope score (VIS). Patients had a median age of 7 years (interquartile range, 4-9). Use of POCUS during fluid management (39/67), as opposed to not using (28/67), was associated with lower mortality (6/39 [15%] vs. 18/28 [64%]; difference 49 % [95% CI, 28-70%], p < 0.001). Use of POCUS was associated with lower odds of death (adjusted odds ratio 0.17 [95% CI, 0.04-0.76], p = 0.02). The utilization of POCUS, versus not, was associated with greater use of resuscitation fluid, and reductions in VIS and pediatric logistic organ dysfunction (PELOD-2) score at 24 hours after MV and PICU discharge. In our experience of pediatric patients with profound DSS and undergoing MV (2013-2021), POCUS use was associated with lower odds of death, a higher volume of resuscitation fluid, and improvements in the blood lactate levels, VIS, and PELOD-2 score.

The effect of blood glucose, blood lactate and creatine kinase levels after carbohydrate-protein supplement uptake on recovery period after exercise in pencak silat athletes

Pencak Silat, a traditional martial art from Southeast Asia, has gained recent popularity, prompting interest in performance enhancement methods. Therefore, The purpose of this study is to examine the effects of carbohydrate-protein supplementation on blood glucose, blood lactate, and creatine kinase levels at the period of recovery after exercise in Pencak Silat Athletes. Materials and Methods: Thirty elite athletes (average age 18-25 years) participated, divided into three groups, each undergoing a 90-minute cycling session at 75% VO₂ max. Participants consumed CHO-PROT, carbohydrate (CHO), or placebo (PLA) drinks 15 minutes before and 45 minutes after exercise. Blood samples were collected before, during, and after exercise. Results: indicated that CHO-PROT and CHO groups exhibited significantly higher blood glucose levels compared to the PLA group (p&lt;0.05), particularly around 75 minutes and 1.5 hours post-exercise. Blood lactate levels did not significantly differ among groups post-exercise. Notably, CHO-PROT consumption led to lower creatine kinase levels compared to CHO and PLA groups (p&lt;0.05), suggesting reduced muscle damage. CHO consumption also demonstrated lower creatine kinase levels compared to the PLA group (p&lt;0.05). Conclusions: CHO-PROT supplementation can elevate blood glucose during post-exercise recovery without influencing blood lactate, highlighting its potential benefits for Pencak Silat athletes.

Atrial fibrillation as a trigger for acute heart failure

Abstract Background Both atrial fibrillation (AF) and heart failure (HF) facilitate the occurrence and aggravate the prognosis of each other, and often coexist (1). Rapid AF is considered to be a trigger for HF decompensation. However, rapid AF can also be secondary to the increase sympathetic drive associated with HF decompensation. Few data are available regarding the hemodynamic and metabolic consequences of rapid AF in acute HF. Purpose To study the clinical impact of rapid AF in acute HF. Methods We studied 8,997 patients admitted with acutely decompensated heart failure (ADHF). Propensity-score matching was generated using 21 clinical variables. The primary endpoint was in-hospital mortality. Results Rapid AF (defined as ventricular rate ≥110) at admission was present in 339 patients (3.8%). Patient with rapid AF had higher prevalence of diabetes, ischemic heart disease chronic lung disease, and higher levels of BUN and white blood cells (All P&amp;lt;0.001). Systolic blood pressure was lower and diastolic blood pressure was higher with rapid AF (Table). Blood lactate levels were slightly higher with rapid AF but the O2 saturation, pH, bicarbonate and pCO2 levels were similar (Table). In a multivariable logistic regression model, adjusting for all available clinical variables, the odds ration (OR) for in hospital mortality was 1.07 (95% CI 0.77 to 1.49; P=0.69). Propensity score matching yielded 338 patient pairs. In-hospital mortality occurred in 16.3% of patients with rapid AF and in 12.7% of patients without rapid AF ( OR 1.34; 95% CI 0.87 to 2.08, P= 0.19). Conclusion Rapid AF at admission was not associated with a significant hemodynamic or metabolic compromise and carried a similar risk for in-hospital mortality as in patients without rapid AF.Hemodynamic and metabolic parameters

Prognostic value of combined central venous oxygen saturation and lactate in pediatric patients after cardiac surgery

ObjectivesThis study assessed the value of measuring both arterial lactate levels and central venous oxygen saturation (ScvO2) in predicting cardiac surgery outcomes in pediatric patients.MethodsA prospective cohort study was conducted on 73 patients who underwent surgery for congenital heart disease. Vasoactive-inotropic score (VIS), serial mean arterial blood pressures (MAP), lactate levels, and ScvO2 were measured immediately and 3, 6, 12, 18, and 24 h after admission to the pediatric intensive care unit (PICU). To test the prognostic values of these markers, we calculated the areas under the receiver operating characteristic curves (AUCs). Binary logistic regression was used to identify the determinants of postsurgical complications.ResultsThe most common complications after cardiac surgery were the prolonged need for mechanical ventilation (38.36%), chest infection (30.14%), prolonged stay in the PICU (24.66%), and sepsis (9.59%). ScvO2 6 h after admission was most predictive of complications (AUC = 85.5%), followed by ScvO2/lactate (AUC = 83.0%), lactate level 12 h after admission (AUC = 75.0%), MAP (AUC = 73.6%), and VIS (AUC = 63.4). In multivariate analysis, body weight and ScvO2 6 h after PICU admission were the main predictors of complications (OR = 0.01, 95% CI 0.001–0.689, p = 0.033), and (OR = 0.87, 95% CI 0.798–0.948, p = 0.002) respectively.ConclusionsTo predict complications after pediatric cardiac surgery, lactate measurement does not add value to ScvO2 measurement 6 h after admission.The Cochrane TRNPACTR202104905893217.Date of registration 12 April 2021.

Association between Serum Lactate and Morbidity and Mortality in Neonates: A Systematic Review and Meta-Analysis.

Lactate is a marker of hypoperfusion in critically ill patients. Whether lactate is useful for identifying and stratifying neonates with a higher risk of adverse outcomes remains unknown. This study aimed to investigate the association between lactate and morbidity and mortality in neonates. A meta-analysis was performed to determine the association between blood lactate levels and outcomes in neonates. Ovid MEDLINE, EMBASE, Cochrane Library, and ClinicalTrials.gov were searched from inception to 1 May 2021. A total of 49 observational studies and 14 data accuracy test studies were included. The risk of bias was assessed using the Newcastle-Ottawa Scale for observational studies and the QUADAS-2 tool for data accuracy test studies. The primary outcome was mortality, while the secondary outcomes included acute kidney injury, necessity for renal replacement therapy, neurological outcomes, respiratory morbidities, hemodynamic instability, and retinopathy of prematurity. Of the 3184 articles screened, 63 studies fulfilled all eligibility criteria, comprising 46,069 neonates. Higher lactate levels are associated with mortality (standard mean difference, -1.09 [95% CI, -1.46 to -0.73]). Using the estimated sensitivity (0.769) and specificity (0.791) and assuming a prevalence of 15% for adverse outcomes (median of prevalence among studies) in a hypothetical cohort of 10,000 neonates, assessing the lactate level alone would miss 346 (3.46%) cases (false negative) and wrongly diagnose 1776 (17.76%) cases (false positive). Higher lactate levels are associated with a greater risk of mortality and morbidities in neonates. However, our results do not support the use of lactate as a screening test to identify adverse outcomes in newborns. Research efforts should focus on analyzing serial lactate measurements, rather than a single measurement.

Abstract 100: Blood Pressure Targets and Hemodynamics According to Initial Blood Lactate Levels in Patients With Comatose Out-of-Hospital Cardiac Arrest - A Substudy of the BOX Trial

Out-of-hospital cardiac arrest (OHCA) patients are often circulatory unstable and have high mortality in the first days following resuscitation. An increase in lactate will reflect the severity and duration of hypoperfusion in out-of-hospital cardiac arrest (OHCA). Further, the severity of hypoperfusion could modify the effect on survival and neurological injury of different mean arterial blood pressure (MAP) targets. In this sub-study of the BOX trial, adults successfully resuscitated comatose OHCA patients (n=789) with a presumed cardiac cause were randomized to a MAP 63 mmHg vs. 77 mmHg. Patients were arbitrarily grouped in low-lactate: &lt;25%, medium-lactate: 25%-75%, and high &gt;75 % according to blood lactate levels at hospital arrival as a surrogate of severity of hypoperfusion. Invasive evaluations were performed using an arterial line and pulmonary artery catheter (PAC). Logistic regression analysis evaluated whether lactate levels (as continuous and categorical) modify the effect of MAP targets on 1-year mortality. The three lactate groups were: low-lactate: &lt;2.9 mmol/L, medium-lactate: 2.9-7.9 mmol/L, and high-lactate &gt;7.9 mmol/L. The vasoactive inotropic score was higher with increasing initial lactate level with the largest difference at 6 hours (low-lactate: 7.8 (95%CI: 5.7 - 10.1) vs. high-lactate: 16.4 (95%CI: 13.4 - 19.6). No difference in the cardiac index or systemic vascular resistance was observed between lactate groups. The initial lactate level modified the effect of the two MAP targets (p=0.044), with a tendency to higher mortality for high-lactate patients if the MAP target were 77 mmHg (odds ratio: 1.7 (95%CI: 0.9-3.0, p=0.08). Comatose OHCA patients with high initial lactate levels required more vasoactive drugs on the first two days of ICU admission to meet the blood pressure target and have a poorer prognosis. The results do not support a higher MAP target benefit for patients with an initial high lactate level in the first 48 hours.

IMPACT OF PARAVERTEBRAL BLOCKADE ON THE COURSE OF EARLY POSTOPERATIVE PERIOD FOLLOWING SURGICAL INTERVENTION FOR LUNG MALIGNANCIES UNDER INHALED SEVOFLURANE ANESTHESIA

The aim of the study is to investigate the impact of paravertebral blockade on the quality of anti-stress protection of general inhalation anaesthesia based on sevoflurane during operations in patients with lung malignancy. Material and methods. We examined 60 individuals of an average age 55±5.6 years, whose physical status was assessed as class II – III according to the ASA classification. The patients underwent open surgical procedures, including frontal or pneumonectomy, or partial lung resection. The patients were divided into 2 groups depending on the method of anaesthesia: SF group (sevoflurane) (n = 29) received inhaled anaesthesia with sevoflurane; SF+PVB group (n = 31) received the combination of inhaled anaesthesia with PVB. The following indicators were assessed: time of the first administration of the analgesic after surgery, pain intensity by the visual analogue scale (VAS), perfusion systemic pressure (PST), cardiac index (CI), oxygen content in arterial and venous blood, blood lactate levels, indicators of circulatory energy efficiency, cortisol, insulin and HOMA index levels. Indicators were recorded before the surgical operation, at the wake-up stage, on the 1st and 5th days following the operation. Results. In the SF+PVB group, the intensity of pain in the postoperative period was significantly lower than in the SF group. In the SF+PVB group, there was no necessity for administering narcotic analgesics on the first day, while in the SF group, the dose of morphine was 0.27±0.04 mg/kg∙day, the first administration was performed 65.5±10.3 minutes after surgery. CI during surgery and in a day was significantly higher in the SF+PVB group, and the arteriovenous difference in oxygen content was significantly lower. The energy efficiency of blood circulation at the same stages was significantly higher in the SF+PVB group. In the same group, there was a significantly lower concentration of markers of stress responses (cortisol levels and HOMA index). Conclusions. The use of paravertebral blockade under the general anaesthesia based on sevoflurane during operations in patients with lung malignancies contributes to a significant reduction in the pain intensity in the postoperative period; eliminates the need to use narcotic analgesics; provides significantly more stable hemodynamics and significantly more adequate oxygen supply during the operation and in the postoperative period; significantly reduces the intensity of stress reactions as well as significantly improves the energy efficiency of blood circulation.

Relationships between selected performance parameters and body composition in karate

Introduction: Studying the somatic characteristics of karate athletes can provide specific details on the morphological and functional factors best suited for this combat sport. Aim: The aim of the present study was to assess the relationship between selected aerobic and anaerobic parameters and the body composition of karate athletes. Materials and Methods: The study included 6 male karate athletes, medalists from European and world championships in senior categories, with a mean age of 28 3 years. The inclusion criteria were training experience and sports skill level. Body composition was assessed using bioimpedance analysis. To evaluate special aerobic endurance parameters, a specific karatespecific aerobic test was used, along with monitoring of heart rate and changes in blood lactate levels. The Wingate test was chosen to determine the level of anaerobic performance. Results: The findings of the present study indicate that body composition is correlated with aerobic and anaerobic variables of karate athletes. Conclusions: These results indicate that karate athletes with a lower body fat mass perform techniques during the fight with higher intensity but with less power. On the contrary, those with a higher percentage of body fat perform techniques with less intensity but they use more power to perform a punch or kick. A low percentage of body fat and body fat mass have a positive effect on the level of anaerobic capacity, which increases with decreasing percentage and amount of body fat.