Lactate Clearance As a predictor of mortality in trauma patients Reno Rudiman

Why do we need predictor? 2

Important in clinical uncertainty Mis-inference may result in an increased risk of an adverse event Avoiding unnecessary cost of care 3 Why do we need predictor?

Mortality of trauma 4

10% of all deaths are caused by trauma (Maegel 2010) In Indonesia 2011, there were traffic accidents, of which dead (BPS, 2011) 5

Lactate End product of anaerobic metabolism Marker for cellular hypoxia in shock Early identification of severe injury

Lactate clearance Rapid clearance of lactate is associated with improved outcome in septic shock & critically ill Is it a better indicator for ongoing tissue hypoperfusion? Better guide for resuscitation?

Lactate clearance Lactate clearance = ([Lactateinitial – Lactatedelayed]/ Lactateinitial) × 100 × Delay−1 (expressed as %/h) 8

Admission Lactate Pal JD, et al. J Trauma 2006; 60:

Initial lactate: survivors vs nonsurvivors 10 Pal JD, et al. J Trauma 2006; 60:

Admission Lactate Although mean admission lactate was significantly lower in survivors than nonsurvivors, the overlap between the groups was so great that little ability to discriminate survivors from non-survivors is apparent 11 Pal JD, et al. J Trauma 2006; 60:

SBP on mortality 12 Odom et al. J Trauma Acute Care Surg 2013; 74(4):

Survival probability 13 Odom et al. J Trauma Acute Care Surg 2013; 74(4):

Relationship of lactate and ISS values in 5,995 trauma patients 14 Pal JD, et al. J Trauma 2006; 60:

Lactate on mortality Odom et al. J Trauma Acute Care Surg 2013; 74(4):

Lactate on mortality 16 Regnier, et al. Anesthesiology 2012; 71(6):

17 Regnier, et al. Anesthesiology 2012; 71(6): Lactate on mortality

18 Successful vs failed Non Operative management in blunt abdominal trauma Haryatama, Rudiman, Sulthana. In publication, 2012.

19 Haryatama, Rudiman, Sulthana. In publication, Successful vs failed Non Operative management in blunt abdominal trauma

Mortality according to initial blood lactate level and/or lactate clearance (n = 453) 20 Regnier, et al. Anesthesiology 2012; 71(6):

21

Conclusion Lactate clearance provides additional predictive information to initial blood lactate levels and scores Lactate clearance is a useful prognostic variable in trauma patients. 22