Journal of critical care · 2024
Effect of pulmonary artery catheter, type & combination of vasoactives for optimizing lactate clearance in acute myocardial infarction complicated by cardiogenic shock.
СтатьяНазвание и аннотация: Перевод в очереди
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Ortega-Hernández Jorge A, González-Pacheco Héctor, García-Ruiz Mauricio, Manzur-Sandoval Daniel, Gopar-Nieto Rodrigo, Sierra-Lara-Martínez Daniel, Araiza-Garaygordobil Diego, Mendoza-García Salvador, Arzate-Ramírez Arturo, Montañez-Orozco Álvaro, Baeza-Herrera Luis Augusto, Altamirano-Castillo Alfredo, Valdespino Trejo Adrian Aquiles, Hernández-Montfort Jaime, Arias-Mendoza Alexandra
Аннотация
INTRODUCTION: Lactate clearance(LC) is critical in managing critically ill patients. We hypothesized that treatment allocation with different vasoactive drugs or the presence of a pulmonary artery catheter (PAC) could affect the behavior of lactate dynamics and, ultimately, the mortality in AMI-CS.
MATERIALS AND METHODS: In 651 patients with AMI-CS, we examined the relationship of LC time with clinical, laboratory, and CS-management variables. Complete LC time was defined as serum lactate levels less than <2 mmol/L. We explore the impact of vasoactive drugs and PAC with LC. The CART method defined the vasoactive combinations (permutations) in relation with early (<96 h) complete LC.
RESULTS: PAC presence correlated with faster LC (-17.54 h) and was independently associated with lower mortality (HR = 0.61). Levosimendan and dobutamine were associated with lower lactate levels and faster LC (-8.82 & -8.77 h), while vasopressin was linked to slower LC (9.16 h). Slow LC (>96 h) was associated with increased mortality. CART analysis identified specific vasoactive drug combinations associated lactate clearance and mortality, without dobutamine, with vasopressin having higher mortality (80.6 %, HR = 5.53), and with dobutamine, with norepinephrine, without vasopressin, with levosimendan the lowest (35 %) and higher complete LC and a trend for higher %LC.
CONCLUSION: The right combination of vasoactive medications and the probable use of a PAC could significantly impact the achievement of complete LC in <96 h. The findings support the need for further research and the development of strategies to optimize lactate clearance and improve overall patient survival in this high-risk population.
MATERIALS AND METHODS: In 651 patients with AMI-CS, we examined the relationship of LC time with clinical, laboratory, and CS-management variables. Complete LC time was defined as serum lactate levels less than <2 mmol/L. We explore the impact of vasoactive drugs and PAC with LC. The CART method defined the vasoactive combinations (permutations) in relation with early (<96 h) complete LC.
RESULTS: PAC presence correlated with faster LC (-17.54 h) and was independently associated with lower mortality (HR = 0.61). Levosimendan and dobutamine were associated with lower lactate levels and faster LC (-8.82 & -8.77 h), while vasopressin was linked to slower LC (9.16 h). Slow LC (>96 h) was associated with increased mortality. CART analysis identified specific vasoactive drug combinations associated lactate clearance and mortality, without dobutamine, with vasopressin having higher mortality (80.6 %, HR = 5.53), and with dobutamine, with norepinephrine, without vasopressin, with levosimendan the lowest (35 %) and higher complete LC and a trend for higher %LC.
CONCLUSION: The right combination of vasoactive medications and the probable use of a PAC could significantly impact the achievement of complete LC in <96 h. The findings support the need for further research and the development of strategies to optimize lactate clearance and improve overall patient survival in this high-risk population.