Lactate Levels as Predictors of the Relationship between Oxygen Delivery and Consumption in ARDS: Discussion (1)


18 Jan 2013

The results of this study confirm that a supply-dependent Vo2 response is characteristic of patients with ARDS and elevated blood lactate concentrations, whereas patients without hyperlactatemia appear to be supply independent with respect to tissue oxygenation. These findings suggest that the pattern of oxygen utilization in ARDS may be biphasic and support the hypothesis that a systemic oxygen debt, as exemplified by increased blood lactate, is a characteristic of supply-dependent behavior. buy levaquin online
The results of the study of patients with ARDS reported by Bihari and co-workers are similar to the findings we report herein. Bihari et al found that a group of nonsurvivors exhibited significant increases in Vo2 in response to a prostacyclin-induced increase in Do2. In contrast, a significant increase in Vo2 was not observed in a group of survivors. Although blood lactate levels or other markers of anaerobic metabolism were not measured in that study, the biphasic nature of oxygen utilization was interpreted to confirm the presence of an oxygen debt in patients who subsequently died. Supportive of this interpretation is our observation that mortality was significantly higher in those patients with increased blood lactate. Other studies have also shown that the lactate concentration is inversely correlated with survival. In another investigation of ARDS reported by Annat and colleagues, patients without lactic acidosis exhibited supply-independent behavior.

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