A PARAMETER AFFECTING THE PRE-HOSPITAL APPROACH: CAPILLARY LACTATE MEASUREMENT

Öz

Lactate is an important parameter that is used to determine tissue hypoxia, which is usually elevated in hypoperfusion situations as a product by anaerobic metabolism. Today, it is of great importance to determine the lactate level of patients in healthcare institutions, especially in emergency services. The increase in lactate level gives information about mortality and morbidity, therefore it significantly affects the emergency approach to patients. The measurement of lactate level is done venous or arterial in the hospital. In recent years, measuring lactate level has become simple and fast. Fingertip capillary lactate measurement can be made with portable devices. Portable compact lactate analyzers have been developed that allow determining the lactate value even before the hospital without special skills. It is reported that these analyzers can guide the rapid detection of patients in critical condition before the hospital and guide the healthcare professionals to make the right decision in triage. In our country, these devices are not being used in emergency ambulances yet and there is no study on the subject. On the other hand, the importance of having portable compact lactate analyzers in ambulances abroad and accepting lactate as a stimulating and directing biomarker is emphasized.

Anahtar Kelimeler

• emergency department
• ambulance
• biomarker
• prehospital
• lactic acid

HASTANE ÖNCESİ YAKLAŞIMI ETKİLEYEN BİR PARAMETRE: KAPİLLER LAKTAT ÖLÇÜMÜ

Öz

Laktat, genellikle anaerobik metabolizmanın yan ürünü olarak hipoperfüzyon durumlarında yükselen ve doku hipoksisini belirlemede kullanılan önemli bir parametredir. Günümüzde sağlık hizmeti veren kurumlarda özellikle de acil servislerde hastalardaki laktat düzeyinin belirlenmesi büyük önem taşımaktadır. Çünkü laktat seviyesindeki artış mortalite ve morbidite hakkında bilgi vermekte bu nedenle hastalara olan acil yaklaşımı önemli ölçüde etkilemektedir. Laktat seviyesi ölçümü hastane ortamında venöz veya arteriyel yapılmaktadır. Son yıllarda ise laktat seviyesini ölçmek basit ve hızlı bir hale gelmiştir. Portatif cihazlar ile parmak ucu kapiller laktat ölçümü yapılabilmektedir. Özel beceri gerektirmeden hastane öncesinde de laktat değerini belirlemeye olanak sağlayan portatif kompakt laktat analizörleri geliştirilmiştir. Bu analizörlerin hastane öncesi kritik durumdaki hastaların hızlı tespit edilmesine ve sağlık profesyonellerine triyajda doğru karar almalarına yol gösterici olabileceği bildirilmektedir. Ülkemizde henüz acil yardım ambulanslarında bu cihazlar kullanılmamaktadır. Yurt dışında ise portatif kompakt laktat analizörlerinin ambulanslarda bulunmasının ve laktatın uyarıcı ve yönlendirici bir biyobelirteç olarak kabul edilmesinin önemi vurgulanmaktadır.

Anahtar Kelimeler

• acil servis
• ambulans
• biyobelirteç
• hastane öncesi
• laktik asit

Kaynakça

1. Adam, Z, Tobias, FX, Guyette, CW, Seymour, Suffoletto, BP, Gill, CM, Quintero, J, et al. (2015). Pre-Resuscitation Lactate and Hospital Mortality in Prehospital Patients. Prehospital Emergency Care, 18(3),321-327.
2. Alam, F, Roychoudhury, S, Jalat, HA, et al. (2018). Lactate Biosensing: The Emerging Point-of-Care and Personal Health Monitoring. Biosensors Bioelectronics,15(117),818-829.
3. Anıl, M, Köse, E, Köse, S, Anıl, AB, Kaplan, SY, Barış, M ve ark. (2014). Acil Serviste İleri Yaşam Desteği Uygulanan Çocuklarda Erken Mortalite Belirteçleri. Çocuk Acil ve Yoğun Bakım Dergisi,1(1):17-24.
4. Ayık, Cİ, Değerli, V, Yılmaz, G, Sevim, E. (2018). Laktat Seviyesinin Üst Gastrointestinal Sistem Kanamalı Hastalarda Prognostik Amaçlı Kullanımı. Kafkas Tıp Bilimleri Dergisi,8(2),115–120.
5. Broder, G, Weil, MH. (1964). Excess Lactate: An İndex of Reversibility of Shock in Human Patients. Science,143,1457–1459.
6. Brown, LH, Hubble, MW, Cone, DC. (2009). Paramedic Determinations of Medical Necessity: A Meta-analysis. Prehospital Emergency Care,13(4),516-527.
7. Coats, TJ, Smith, JE, Lockey, D, Russell, M. (2002). Early Increases in Blood Lactate Following Injury. Journal of the Royal Army Medical Corps,148,140-143.
8. Çağlayan, T, Özakın, E, Özdemir, AÖ, Acar, N, Çanakçı, ME, Arslan, E ve ark. (2021). Hemorajik ve İskemik Serebrovasküler Hastalık Tanısı Alan Hastalarda Kan Laktat Düzeyinin Prognoz Üzerine Etkisi. Osmangazi Tıp Dergisi, 43(2),115-121.

9. Feldman, MJ, Verbeek, PR, Lyons, DG, Chad, SJ, Craig, AM, Schwartz, B. (2006). Comparison of the Medical Priority Dispatch System to an Out-of-Hospital Patient Acuity Score.Comparative Study,13(9),954-960.
10. Fuller, BM, Dellinger, RP. (2012). Lactate as a Hemodynamic Marker in the Critically Ill. Current Opinion in Critical Care,18(3):267-272.
11. Garcia-Alvarez, M, Marik, P, Bellomo, R. (2014). Sepsis-Associated Hyperlactatemia. Critical Care,18(503),2-11.
12. Griggs, JE, Lyon, RM, Sherriff, M, et al. (2022). Predictive Clinical Utility of Pre-Hospital Point of Care Lactate For Transfusion of Blood Product in Patients With Suspected Traumatic Haemorrhage: Derivation of A Decision-Support Tool. Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 30(1),72-82
13. Guyette, F, Suffoletto, B, Castillo, JL, Quintero, J, Callaway, C, Puyana, JC. (2011). Prehospital Serum Lactate As A Predictor of Outcomes in Trauma Patients: A Retrospective Observational Study. Journal of Trauma Acute Care Surgery,70,782–786.
14. Jansen, TC, Van Bommel, J, Mulder, PG, Rommes, JH, Schieveld, SJ, Bakker, J. (2008). The Prognostic Value of Blood Lactate Levels Relative to That of Vital Signs in The Prehospital Setting: A Pilot Study. Critical Care, 12(160),1-7.
15. Jansen, TC, Van Bommel, J, Bakker, J. (2009). Blood Lactate Monitoring Incritically Ill Patients: A Systematic Health Technology Assessment. Critical Care Medicine, 37(10),2827–2839.
16. John, AE, McCoy, AM, Moyes, AG, Guyette, FX, Bulger, EM, Sayre, MR. (2018). Prehospital Lactate Predicts Need For Resuscitative Care in Non-Hypotensive Trauma Patients. Western Journal of Emergency Medicine, 19(2),224-231.
17. Leguillier, T, Jouffroy, R, Boisson, M, Boussaroque, A, Chenevier-Gobeaux, C, Chaabouni, T, et al. (2018). Lactate POCT in Mobile İntensive Care Units For Septic Patients? A Comparison of Capillary Blood Method Versus Venous Blood and Plasma-Based Reference Methods. Clinical Biochemistry, 55,9–14.
18. Lewis, CT, Naumann, DN, Crombie, N, Midwinter, MJ. (2016). Prehospital Point-of-Care Lactate Following Trauma: A Systematic Review. Journal of Trauma Acute Care Surgery, 81, 748–755.
19. Magnusson, C, Herlitz, J, Höglind, R, Wennberg, P, Tranberg, AE, Axelsson, C, et al. (2020). Prehospital Lactate Levels in Blood As A Seizure Biomarker: A Multi-Center Observational Study. Epilepsia, 62(2),408-415.
20. Matz, O, Heckelmann, J, Zechbauer, S, Litmathe, J, Brokmann, JC, Willmes, K, et al. (2018). Early Postictal Serum Lactate Concentrations Are Superior To Serum Creatine Kinase Concentrations in Distinguishing Generalized Tonic-Clonic Seizures From Syncopes. Internal and Emergency Medicine,13,749–755.
21. Matz, O, Zdebik, C, Zechbauer, S, Bundgens, L, Litmathe, J, Willmes, K, et al. (2016). Lactate As A Diagnostic Marker in Transient Loss of Consciousness. Seizure,40,71–75.
22. Nakao, T, Fujiwara, S, Isoda, K, Miyahara, T. (1982). Impaired Lactate Production by Skeletal Muscle With Anaerobic Exercise in Patients With Chronic Renal Failure. Nephron, 31(2),111–115.
23. Nguyen, H, Loomba, M, Yang, J, Jacobsen, G, Shah, K, Otero, RM, et al. (2010). Early Lactate Clearance is Associated With Biomarkers of İnflammation, Coagulation, Apoptosis, Organ Dysfunction and Mortality in Severe Sepsis and Septic Shock. Journal of Inflammation, 7(6),1-7.
24. Okarie, NO, Dellinger, P. (2011). Lactate: Biomarker and Potential Therapeutic Target. Critical Care Clinic,27(2),299-326.
25. Raal, A, Sunde, AG, Bolann, B, Kvale, R, Bjerkving, C, Eliassen, HS, et al. (2020). Validation of A Point-Of-Care Capillary Lactate Measuring Device (Lactate Pro 2). Scandinavian Journal of Trauma Resuscitation and Emergency Medicine,28(1),83-89.
26. Rathee, K, Dhull, V, Dhull, R, Singh, S, et al. (2016). Biosensors Based on Electrochemical Lactate Detection: A Comprehensive Review. Biochemistry Biophysics reports, 5,35–54.
27. Rivers, EP. (2009). A Prospective, Multicenter Derivation of A Biomarker Panel to Assess Risk of Organ Dysfunction, Shock, And Death in Emergency Department Patients With Suspected Sepsis. Critical Care Medicine, 37,96-104.
28. Rodríguez, FM, Izquierdo, RL, Benito, JD, García, AS, Vegas, CP, Villamor, MA, et al. (2020a). Prehospital Point-of-Care Lactate Increases The Prognostic Accuracy of National Early Warning Score 2 For Early Risk Stratification of Mortality: Results of A Multicenter, Observational Study. Journal of Clinical Medicine, 18;9(4),1156-1164
29. Rodríguez, FM, Izquierdo, RL, Lozano, EM, Rabbione GO, Vegas, CD, Rodríguez, VC,, et al.(2020b). Accuracy of Prehospital Point-of-Care Lactate in Early in-Hospital Mortality. European Journal of Clinical Investigation,50(12),1-10.
30. Sasser, SM, Hunt, RC, Faul, M, Sugerman, D, Pearson, WS, Dulski, T, Wald, MM, et al. (2012). Guidelines for Field Triage of Injured Patients: Recommendations of The National Expert Panel On Field Triage. Morbidity and Mortality Weekly Report,61(1),1-20.
31. Shah, A, Guyette, F, Suffoletto, B, Schultz, B, Quintero, J, Predis, E, et al. (2013). Diagnostic Accuracy of a Single Point-of-Care Prehospital Serum Lactate for Predicting Outcomes in Pediatric Trauma Patients.Pediatric Emergency Care,29(6),715-719.
32. Shapiro, NI, Howell, MD, Talmor, D, Nathanson, LA, Lisbon, A, Wolfe, RE, et al. (2005). Serum Lactate As A Predictor of Mortality in Emergency Department Patients With Infection. Annals Emergency Medicine,45(5),524-528.
33. Swan, KL, Avard, BJ, Keene, T. (2019).The Relationship Between Elevated Prehospital Point-of-Care Lactate Measurements, Intensive Care Unit Admission, and Mortality: A Retrospective Review of Adult Patients. Australian Critical Care,32(2):100-105.
34. Theerawit, P, Na Petvicharn, C, Tangsujaritvijit, V, et al. (2018). The Correlation Between Arterial Lactate And Venous Lactate In Patients With Sepsis And Septic Shock. Journal of Intensive Care Medicine, 33,116-120.
35. Wardi, G, Brice, J, Correia, M, Liu, D, Self, M, Tainter, C. (2020). Demystifying Lactate in The Emergency Department. Annals of Emergency Medicine, 75(2),287-298.
36. William, TA, Martin, R, Celenza, A, Bremner, A, Fatovich, D, Krause, J, et al. (2016). Use of Serum Lactate Levels to Predict Survival For Patients With Out-of-Hospital Cardiac Arrest: A Cohort Study. Emergency Medicine Australasia, 28(2),171-178.