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Bryan S Richardson - One of the best experts on this subject based on the ideXlab platform.
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umbilical cord ph and Base Excess values in relation to adverse outcome events for infants delivering at term
American Journal of Obstetrics and Gynecology, 2004Co-Authors: Rahi Victory, Renato Natale, Deborah Penava, Orlando Da Silva, Bryan S RichardsonAbstract:Abstract Objective This study was undertaken to determine the relationship of umbilical cord pH and Base Excess (BE) values to adverse neonatal outcomes for a large tertiary hospital population delivering at term. Study design The perinatal/neonatal dataBase of St. Joseph's Health Care, London, Canada, was used to obtain the umbilical cord pH and BE values, incidence of adverse neonatal outcomes, and patient demographics for all term (≥37 weeks' gestation), singleton, liveborn infants with no major anomalies delivering between November 1995 and March 2002 (n=20,456). Statistical analyses included χ 2 analysis, logistic regression models to develop odds ratios and creation of receiver operating characteristic (ROC) curves with area under curve (AUC) calculations. Results Umbilical vein and artery pH and BE values for this tertiary care population averaged 7.33 ± 0.06 and 7.24 ± 0.07, and −4.5 ± 2.4 and −5.6 ± 3.0 mmol/L, respectively. Apgar less than 7 at 5 minutes, neonatal intensive care unit (NICU) admission, and assisted neonatal ventilation had significant inverse relationships with both umbilical artery and umbilical vein pH and BE (all P (P Conclusion There is a progression of risk in term infants for Apgar less than 7 at 5 minutes, NICU admission, and need for assisted ventilation with worsening acidosis at birth, which begins with cord blood values close to mean values indicating a higher threshold for associated acidemia with these outcomes than is seen for more severe neonatal outcomes.
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umbilical cord ph and Base Excess values in relation to neonatal morbidity for infants delivered preterm
American Journal of Obstetrics and Gynecology, 2003Co-Authors: Rahi Victory, Renato Natale, Deborah Penava, Orlando Da Silva, Bryan S RichardsonAbstract:Abstract Objective Our purpose was to determine the relationship/predictive value of umbilical cord pH and Base Excess (BE) values to adverse neonatal outcomes for preterm infants. Study design A tertiary center perinatal/neonatal dataBase was used to obtain umbilical cord pH and BE values, adverse neonatal outcomes, and patient demographics for preterm (PT, 32-36 weeks gestational age) and very preterm (VPT, 25-32 weeks gestational age) singleton live-born infants delivered between November 1995 and March 2002. Results PT (n = 1807) and VPT (n = 603) groups demonstrated a significant inverse curvilinear relationship of umbilical cord pH and BE values to Apgar score Conclusion Umbilical cord pH and BE are related to subsequent adverse outcome events for infants delivered preterm. Worsening acidosis is associated with progressively greater increases in these outcomes with no discriminatory value within or between umbilical artery and umbilical vein pH and BE.
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prediction of umbilical artery Base Excess by intrapartum fetal oxygen saturation monitoring
American Journal of Obstetrics and Gynecology, 1997Co-Authors: Majed Alshimmiri, Alan D Bocking, Robert Gagnon, Renato Natale, Bryan S RichardsonAbstract:Abstract OBJECTIVE: Our purpose was to evaluate the predictive value of intrapartum fetal oxygen saturation as monitored by reflectance pulse oximetry (Spo 2 ) for metabolic acidosis at birth. STUDY DESIGN: An observational study was carried out on intrapartum patients at ≥35 weeks' gestation having either a nonreassuring fetal heart rate pattern, intrauterine growth restriction, or thick meconium. Fetal oxygen saturation monitoring was performed with use of the Nellcor N-400 monitor and the FS-14 fetal oxygen sensor. Mean values of Spo 2 from the last 30 minutes of monitoring were correlated with umbilical artery Base Excess and pH at birth, with use of regression analysis, whereas the prediction of acidosis by Spo 2 at different thresholds was tested with use of receiver-operator characteristic curve calculations. RESULTS: Fifty-four patients met the criteria for data analysis, with a mean Spo 2 monitoring time of 150 ± 124 minutes (SD) and a mean signal loss of 30% ± 20%. Mean fetal Spo 2 for the last 30 minutes of monitoring averaged 42.1% ± 9.9% and, for individual patient studies, correlated significantly with calculated oxygen saturation in the umbilical vein ( r = 0.52, p r = 0.34, p = 0.02) as measured at birth. However, the correlation with umbilical artery Base Excess values at birth was somewhat weaker ( r = 0.30, p r = 0.26, p = 0.05). Receiver-operator characteristic curve calculations were all nonsignificant when Spo 2 from the last 30 minutes of monitoring was used as a diagnostic test for predicting acidosis at birth. CONCLUSIONS: Intrapartum fetal Spo 2 as monitored in the current study was of limited use as a diagnostic test for predicting acidosis at birth, regardless of the Spo 2 cutoff value used. (Am J Obstet Gynecol 1997;177:775-9.)
Marcelo Park - One of the best experts on this subject based on the ideXlab platform.
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effect of paco2 variation on standard Base Excess value in critically ill patients
Journal of Critical Care, 2009Co-Authors: Marcelo Park, Danilo Teixeira Noritomi, Luciano Cesar Pontes Azevedo, Alexandre Toledo Maciel, Leandro Utino Taniguchi, Luiz Monteiro Da Cruz NetoAbstract:Abstract Purpose The aim of this study was to investigate the impact of acute Pa co 2 temporal variation on the standard Base Excess (SBE) value in critically ill patients. Methods A total of 265 patients were prospectively observed; 158 were allocated to the modeling group, and 107 were allocated to the validation group. Two models were developed in the modeling group (one including and one excluding Pa co 2 as a variable determinant of SBE), and both were tested in the validation group. Results In the modeling group, the mathematical model including SIDai, SIG, l -lactate, albumin, phosphate, and Pa co 2 had a predictive superiority in comparison with the model without Pa co 2 (R2 = 0.978 and 0.916, respectively). In the validation group, the results were confirmed with significant F change statistics (R2 change = 0.059, P co 2. A high correlation (R = 0.99, P Conclusions Acute Pa co 2 temporal variation is related to SBE changes in critically ill patients.
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differences in acid Base behavior between intensive care unit survivors and nonsurvivors using both a physicochemical and a standard Base Excess approach a prospective observational study
Journal of Critical Care, 2009Co-Authors: Alexandre Toledo Maciel, Marcelo ParkAbstract:Abstract Purpose This study aimed to test the hypothesis that intensive care unit survivors and nonsurvivors differ with regard to type and severity of acid-Base disorders. Materials and Methods Prospective, observational, cohort study of 107 consecutive patients admitted in a 7-bed intensive care unit during a 6-month period that stayed at least 4 days. All acid-Base variables for the first 3 days and the day of discharge were analyzed. Results Survivors had significant metabolic acidosis upon admission, which was due to hyperlactatemia, an Excess of unmeasured anions, and principally, hyperchloremia. A progressive decrease in these anions in the presence of constant hypoalbuminemia led to normal standard Base Excess at discharge. Nonsurvivors had greater metabolic acidosis upon admission with acidifying variables in similar proportions to that of the survivors. On the day of death, nonsurvivors had a similar degree of metabolic acidosis but a different proportion of the anions (less chloride and more lactate) compared with the day of admission. Unmeasured anions were greater in nonsurvivors both on the day of admission and on the day of death. Conclusions Intensive care unit survivors and nonsurvivors differed in the severity of metabolic acidosis; however, the proportion of the different anions causing the acidosis on admission was similar between these 2 groups.
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clinical utility of standard Base Excess in the diagnosis and interpretation of metabolic acidosis in critically ill patients
Brazilian Journal of Medical and Biological Research, 2008Co-Authors: Marcelo Park, Danilo Teixeira Noritomi, Alexandre Toledo Maciel, Leandro Utino Taniguchi, A B Liborio, L M CruznetoAbstract:The aims of this study were to determine whether standard Base Excess (SBE) is a useful diagnostic tool for metabolic acidosis, whether metabolic acidosis is clinically relevant in daily evaluation of critically ill patients, and to identify the most robust acid-Base determinants of SBE. Thirty-one critically ill patients were enrolled. Arterial blood samples were drawn at admission and 24 h later. SBE, as calculated by Van Slyke's (SBEVS) or Wooten's (SBEW) equations, accurately diagnosed metabolic acidosis (AUC = 0.867, 95%CI = 0.690-1.043 and AUC = 0.817, 95%CI = 0.634-0.999, respectively). SBEVS was weakly correlated with total SOFA (r = -0.454, P < 0.001) and was similar to SBEW (r = -0.482, P < 0.001). All acid-Base variables were categorized as SBEVS <-2 mEq/L or SBEVS <-5 mEq/L. SBEVS <-2 mEq/L was better able to identify strong ion gap acidosis than SBEVS <-5 mEq/L; there were no significant differences regarding other variables. To demonstrate unmeasured anions, anion gap (AG) corrected for albumin (AGA) was superior to AG corrected for albumin and phosphate (AGA+P) when strong ion gap was used as the standard method. Mathematical modeling showed that albumin level, apparent strong ion difference, AGA, and lactate concentration explained SBEVS variations with an R2 = 0.954. SBEVS with a cut-off value of <-2 mEq/L was the best tool to diagnose clinically relevant metabolic acidosis. To analyze the components of SBEVS shifts at the bedside, AGA, apparent strong ion difference, albumin level, and lactate concentration are easily measurable variables that best represent the partitioning of acid-Base derangements.
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partitioning evolutive standard Base Excess determinants in septic shock patients
Revista Brasileira De Terapia Intensiva, 2007Co-Authors: Marcelo Park, Danilo Teixeira Noritomi, Alexandre Toledomaciel, Luciano Cesar Pontes Azevedo, Vladimir Ribeiro Pizzo, L M CruznetoAbstract:BACKGROUND AND OBJECTIVES: The amount of metabolic acidosis measured through the standard Base Excess (SBE) has been shown to be an outcome marker and its improvement has been associated with better survival. We studied the mechanism of standard Base Excess variation in the first three days of intensive care unit (ICU) stay through the evaluation of independent variables of physico-chemical approach. METHODS: Data were retrieved from our prospective collected data Base from patients with diagnosis of septic shock, daily up to the third day after the ICU admission. Single correlations between SBE and independent variables were performed as well as a mathematical multilinear model was built to disclose the SBE variation determinants. RESULTS: We have shown that in septic shock patients the standard Base Excess variation during the first three days of ICU stay is weakly correlated to strong ion gap (SIG), lactate, creatinin and PaCO2 when individually analyzed. Analyzing concomitantly those independent variables, we built a mathematical model with a stepwise multilinear regression composed by apparent strong ion difference (SIDa), SIG, PaCO2, albumin and diuresis that resulted in a R2 coefficient of 0.866 to determine SBE variation. CONCLUSIONS: Variations of metabolic acidosis measured through the standard Base Excess in septic shock patients when analyzed until the third day after intensive care unit admission, is resultant of interaction of several independent determinants as PaCO2, diuresis, SIG, SIDa and albumin.
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metabolic acid Base status in critically ill patients is standard Base Excess correlated with serum lactate level
Revista Brasileira De Terapia Intensiva, 2006Co-Authors: Danilo Teixeira Noritomi, Ricardo Reis Sanga, Andre Carlos Kajdaksiballa Amaral, Marcelo ParkAbstract:BACKGROUND AND OBJECTIVES: To correlate standard Base Excess (SBE) with serum lactate level and demonstrate the independent prognostic significance of each one. METHODS: In a retrospective study, we retrieved data from 333 patients of our prospectively collected dataBase of 7-bed medical intensive care unit of a 1800-bed university hospital. RESULTS: The results have shown a poor correlation between SBE and lactate, r = - 0.358, p < 0.001, and an independent prognostic significance of each one when analyzed concomitantly, odds ratio (95% Confidence interval) = 0.996 (0.992 - 0.999) to standard Base Excess and 1.000 (1.000 - 1.002) to lactate at entrance; and odds ratio (95% Confidence interval ) = 0.990 (0.985 - 0.994) to standard Base Excess and 1.003 (1.001 - 1.005) to lactate after 24 hours. The accuracy of standard Base Excess was close to lactate to determine in-intensive care unit death. CONCLUSIONS: The lactic component of the metabolic acidosis is not the major determinant of standard Base Excess. Serum lactate and SBE are independent outcome predictors in critically ill patients.
Rahi Victory - One of the best experts on this subject based on the ideXlab platform.
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umbilical cord ph and Base Excess values in relation to adverse outcome events for infants delivering at term
American Journal of Obstetrics and Gynecology, 2004Co-Authors: Rahi Victory, Renato Natale, Deborah Penava, Orlando Da Silva, Bryan S RichardsonAbstract:Abstract Objective This study was undertaken to determine the relationship of umbilical cord pH and Base Excess (BE) values to adverse neonatal outcomes for a large tertiary hospital population delivering at term. Study design The perinatal/neonatal dataBase of St. Joseph's Health Care, London, Canada, was used to obtain the umbilical cord pH and BE values, incidence of adverse neonatal outcomes, and patient demographics for all term (≥37 weeks' gestation), singleton, liveborn infants with no major anomalies delivering between November 1995 and March 2002 (n=20,456). Statistical analyses included χ 2 analysis, logistic regression models to develop odds ratios and creation of receiver operating characteristic (ROC) curves with area under curve (AUC) calculations. Results Umbilical vein and artery pH and BE values for this tertiary care population averaged 7.33 ± 0.06 and 7.24 ± 0.07, and −4.5 ± 2.4 and −5.6 ± 3.0 mmol/L, respectively. Apgar less than 7 at 5 minutes, neonatal intensive care unit (NICU) admission, and assisted neonatal ventilation had significant inverse relationships with both umbilical artery and umbilical vein pH and BE (all P (P Conclusion There is a progression of risk in term infants for Apgar less than 7 at 5 minutes, NICU admission, and need for assisted ventilation with worsening acidosis at birth, which begins with cord blood values close to mean values indicating a higher threshold for associated acidemia with these outcomes than is seen for more severe neonatal outcomes.
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umbilical cord ph and Base Excess values in relation to neonatal morbidity for infants delivered preterm
American Journal of Obstetrics and Gynecology, 2003Co-Authors: Rahi Victory, Renato Natale, Deborah Penava, Orlando Da Silva, Bryan S RichardsonAbstract:Abstract Objective Our purpose was to determine the relationship/predictive value of umbilical cord pH and Base Excess (BE) values to adverse neonatal outcomes for preterm infants. Study design A tertiary center perinatal/neonatal dataBase was used to obtain umbilical cord pH and BE values, adverse neonatal outcomes, and patient demographics for preterm (PT, 32-36 weeks gestational age) and very preterm (VPT, 25-32 weeks gestational age) singleton live-born infants delivered between November 1995 and March 2002. Results PT (n = 1807) and VPT (n = 603) groups demonstrated a significant inverse curvilinear relationship of umbilical cord pH and BE values to Apgar score Conclusion Umbilical cord pH and BE are related to subsequent adverse outcome events for infants delivered preterm. Worsening acidosis is associated with progressively greater increases in these outcomes with no discriminatory value within or between umbilical artery and umbilical vein pH and BE.
Renato Natale - One of the best experts on this subject based on the ideXlab platform.
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umbilical cord ph and Base Excess values in relation to adverse outcome events for infants delivering at term
American Journal of Obstetrics and Gynecology, 2004Co-Authors: Rahi Victory, Renato Natale, Deborah Penava, Orlando Da Silva, Bryan S RichardsonAbstract:Abstract Objective This study was undertaken to determine the relationship of umbilical cord pH and Base Excess (BE) values to adverse neonatal outcomes for a large tertiary hospital population delivering at term. Study design The perinatal/neonatal dataBase of St. Joseph's Health Care, London, Canada, was used to obtain the umbilical cord pH and BE values, incidence of adverse neonatal outcomes, and patient demographics for all term (≥37 weeks' gestation), singleton, liveborn infants with no major anomalies delivering between November 1995 and March 2002 (n=20,456). Statistical analyses included χ 2 analysis, logistic regression models to develop odds ratios and creation of receiver operating characteristic (ROC) curves with area under curve (AUC) calculations. Results Umbilical vein and artery pH and BE values for this tertiary care population averaged 7.33 ± 0.06 and 7.24 ± 0.07, and −4.5 ± 2.4 and −5.6 ± 3.0 mmol/L, respectively. Apgar less than 7 at 5 minutes, neonatal intensive care unit (NICU) admission, and assisted neonatal ventilation had significant inverse relationships with both umbilical artery and umbilical vein pH and BE (all P (P Conclusion There is a progression of risk in term infants for Apgar less than 7 at 5 minutes, NICU admission, and need for assisted ventilation with worsening acidosis at birth, which begins with cord blood values close to mean values indicating a higher threshold for associated acidemia with these outcomes than is seen for more severe neonatal outcomes.
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umbilical cord ph and Base Excess values in relation to neonatal morbidity for infants delivered preterm
American Journal of Obstetrics and Gynecology, 2003Co-Authors: Rahi Victory, Renato Natale, Deborah Penava, Orlando Da Silva, Bryan S RichardsonAbstract:Abstract Objective Our purpose was to determine the relationship/predictive value of umbilical cord pH and Base Excess (BE) values to adverse neonatal outcomes for preterm infants. Study design A tertiary center perinatal/neonatal dataBase was used to obtain umbilical cord pH and BE values, adverse neonatal outcomes, and patient demographics for preterm (PT, 32-36 weeks gestational age) and very preterm (VPT, 25-32 weeks gestational age) singleton live-born infants delivered between November 1995 and March 2002. Results PT (n = 1807) and VPT (n = 603) groups demonstrated a significant inverse curvilinear relationship of umbilical cord pH and BE values to Apgar score Conclusion Umbilical cord pH and BE are related to subsequent adverse outcome events for infants delivered preterm. Worsening acidosis is associated with progressively greater increases in these outcomes with no discriminatory value within or between umbilical artery and umbilical vein pH and BE.
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prediction of umbilical artery Base Excess by intrapartum fetal oxygen saturation monitoring
American Journal of Obstetrics and Gynecology, 1997Co-Authors: Majed Alshimmiri, Alan D Bocking, Robert Gagnon, Renato Natale, Bryan S RichardsonAbstract:Abstract OBJECTIVE: Our purpose was to evaluate the predictive value of intrapartum fetal oxygen saturation as monitored by reflectance pulse oximetry (Spo 2 ) for metabolic acidosis at birth. STUDY DESIGN: An observational study was carried out on intrapartum patients at ≥35 weeks' gestation having either a nonreassuring fetal heart rate pattern, intrauterine growth restriction, or thick meconium. Fetal oxygen saturation monitoring was performed with use of the Nellcor N-400 monitor and the FS-14 fetal oxygen sensor. Mean values of Spo 2 from the last 30 minutes of monitoring were correlated with umbilical artery Base Excess and pH at birth, with use of regression analysis, whereas the prediction of acidosis by Spo 2 at different thresholds was tested with use of receiver-operator characteristic curve calculations. RESULTS: Fifty-four patients met the criteria for data analysis, with a mean Spo 2 monitoring time of 150 ± 124 minutes (SD) and a mean signal loss of 30% ± 20%. Mean fetal Spo 2 for the last 30 minutes of monitoring averaged 42.1% ± 9.9% and, for individual patient studies, correlated significantly with calculated oxygen saturation in the umbilical vein ( r = 0.52, p r = 0.34, p = 0.02) as measured at birth. However, the correlation with umbilical artery Base Excess values at birth was somewhat weaker ( r = 0.30, p r = 0.26, p = 0.05). Receiver-operator characteristic curve calculations were all nonsignificant when Spo 2 from the last 30 minutes of monitoring was used as a diagnostic test for predicting acidosis at birth. CONCLUSIONS: Intrapartum fetal Spo 2 as monitored in the current study was of limited use as a diagnostic test for predicting acidosis at birth, regardless of the Spo 2 cutoff value used. (Am J Obstet Gynecol 1997;177:775-9.)
Danilo Teixeira Noritomi - One of the best experts on this subject based on the ideXlab platform.
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effect of paco2 variation on standard Base Excess value in critically ill patients
Journal of Critical Care, 2009Co-Authors: Marcelo Park, Danilo Teixeira Noritomi, Luciano Cesar Pontes Azevedo, Alexandre Toledo Maciel, Leandro Utino Taniguchi, Luiz Monteiro Da Cruz NetoAbstract:Abstract Purpose The aim of this study was to investigate the impact of acute Pa co 2 temporal variation on the standard Base Excess (SBE) value in critically ill patients. Methods A total of 265 patients were prospectively observed; 158 were allocated to the modeling group, and 107 were allocated to the validation group. Two models were developed in the modeling group (one including and one excluding Pa co 2 as a variable determinant of SBE), and both were tested in the validation group. Results In the modeling group, the mathematical model including SIDai, SIG, l -lactate, albumin, phosphate, and Pa co 2 had a predictive superiority in comparison with the model without Pa co 2 (R2 = 0.978 and 0.916, respectively). In the validation group, the results were confirmed with significant F change statistics (R2 change = 0.059, P co 2. A high correlation (R = 0.99, P Conclusions Acute Pa co 2 temporal variation is related to SBE changes in critically ill patients.
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clinical utility of standard Base Excess in the diagnosis and interpretation of metabolic acidosis in critically ill patients
Brazilian Journal of Medical and Biological Research, 2008Co-Authors: Marcelo Park, Danilo Teixeira Noritomi, Alexandre Toledo Maciel, Leandro Utino Taniguchi, A B Liborio, L M CruznetoAbstract:The aims of this study were to determine whether standard Base Excess (SBE) is a useful diagnostic tool for metabolic acidosis, whether metabolic acidosis is clinically relevant in daily evaluation of critically ill patients, and to identify the most robust acid-Base determinants of SBE. Thirty-one critically ill patients were enrolled. Arterial blood samples were drawn at admission and 24 h later. SBE, as calculated by Van Slyke's (SBEVS) or Wooten's (SBEW) equations, accurately diagnosed metabolic acidosis (AUC = 0.867, 95%CI = 0.690-1.043 and AUC = 0.817, 95%CI = 0.634-0.999, respectively). SBEVS was weakly correlated with total SOFA (r = -0.454, P < 0.001) and was similar to SBEW (r = -0.482, P < 0.001). All acid-Base variables were categorized as SBEVS <-2 mEq/L or SBEVS <-5 mEq/L. SBEVS <-2 mEq/L was better able to identify strong ion gap acidosis than SBEVS <-5 mEq/L; there were no significant differences regarding other variables. To demonstrate unmeasured anions, anion gap (AG) corrected for albumin (AGA) was superior to AG corrected for albumin and phosphate (AGA+P) when strong ion gap was used as the standard method. Mathematical modeling showed that albumin level, apparent strong ion difference, AGA, and lactate concentration explained SBEVS variations with an R2 = 0.954. SBEVS with a cut-off value of <-2 mEq/L was the best tool to diagnose clinically relevant metabolic acidosis. To analyze the components of SBEVS shifts at the bedside, AGA, apparent strong ion difference, albumin level, and lactate concentration are easily measurable variables that best represent the partitioning of acid-Base derangements.
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partitioning evolutive standard Base Excess determinants in septic shock patients
Revista Brasileira De Terapia Intensiva, 2007Co-Authors: Marcelo Park, Danilo Teixeira Noritomi, Alexandre Toledomaciel, Luciano Cesar Pontes Azevedo, Vladimir Ribeiro Pizzo, L M CruznetoAbstract:BACKGROUND AND OBJECTIVES: The amount of metabolic acidosis measured through the standard Base Excess (SBE) has been shown to be an outcome marker and its improvement has been associated with better survival. We studied the mechanism of standard Base Excess variation in the first three days of intensive care unit (ICU) stay through the evaluation of independent variables of physico-chemical approach. METHODS: Data were retrieved from our prospective collected data Base from patients with diagnosis of septic shock, daily up to the third day after the ICU admission. Single correlations between SBE and independent variables were performed as well as a mathematical multilinear model was built to disclose the SBE variation determinants. RESULTS: We have shown that in septic shock patients the standard Base Excess variation during the first three days of ICU stay is weakly correlated to strong ion gap (SIG), lactate, creatinin and PaCO2 when individually analyzed. Analyzing concomitantly those independent variables, we built a mathematical model with a stepwise multilinear regression composed by apparent strong ion difference (SIDa), SIG, PaCO2, albumin and diuresis that resulted in a R2 coefficient of 0.866 to determine SBE variation. CONCLUSIONS: Variations of metabolic acidosis measured through the standard Base Excess in septic shock patients when analyzed until the third day after intensive care unit admission, is resultant of interaction of several independent determinants as PaCO2, diuresis, SIG, SIDa and albumin.
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metabolic acid Base status in critically ill patients is standard Base Excess correlated with serum lactate level
Revista Brasileira De Terapia Intensiva, 2006Co-Authors: Danilo Teixeira Noritomi, Ricardo Reis Sanga, Andre Carlos Kajdaksiballa Amaral, Marcelo ParkAbstract:BACKGROUND AND OBJECTIVES: To correlate standard Base Excess (SBE) with serum lactate level and demonstrate the independent prognostic significance of each one. METHODS: In a retrospective study, we retrieved data from 333 patients of our prospectively collected dataBase of 7-bed medical intensive care unit of a 1800-bed university hospital. RESULTS: The results have shown a poor correlation between SBE and lactate, r = - 0.358, p < 0.001, and an independent prognostic significance of each one when analyzed concomitantly, odds ratio (95% Confidence interval) = 0.996 (0.992 - 0.999) to standard Base Excess and 1.000 (1.000 - 1.002) to lactate at entrance; and odds ratio (95% Confidence interval ) = 0.990 (0.985 - 0.994) to standard Base Excess and 1.003 (1.001 - 1.005) to lactate after 24 hours. The accuracy of standard Base Excess was close to lactate to determine in-intensive care unit death. CONCLUSIONS: The lactic component of the metabolic acidosis is not the major determinant of standard Base Excess. Serum lactate and SBE are independent outcome predictors in critically ill patients.
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evolutive standard Base Excess and serum lactate level in severe sepsis and septic shock patients resuscitated with early goal directed therapy still outcome markers
Clinics, 2006Co-Authors: Marcelo Park, Danilo Teixeira Noritomi, Luciano Cesar Pontes Azevedo, Vladimir Ribeiro Pizzo, Alexandre Toledo Maciel, Luiz Monteiro Da Cruz NetoAbstract:OBJETIVO: Comparar a evolucao do "standard Base Excess" e o nivel de lactato serico entre pacientes sobreviventes e nao sobreviventes com sepse grave ou choque septico reanimados com o "early goal directed therapy". METODOS: Estudo retrospectivo em uma unidade de terapia intensiva de um hospital escola onde sessenta e cinco pacientes com sepse grave e choque septico foram observados sem intervencoes. RESULTADOS: Em nosso estudo, a mortalidade na sepse grave e choque septico foi de 38%. A saturacao venosa central de oxigenio nos dois grupos foi maior que 70% depois da reanimacao, exceto no segundo dia no grupo dos pacientes nao sobreviventes (69,8%). Depois do segundo dia, a saturacao venosa central foi significantemente maior no grupo dos sobreviventes (p<0.001). O "standard Base Excess" foi inicialmente baixo em ambos os grupos, mas a partir do segundo dia a recuperacao do "standard Base Excess" foi significantemente mais importante e linear no grupo dos sobreviventes (p<0.001). Os niveis de lactato foram similares na evolucao dos dois grupos. DISCUSSAO: O "standard Base Excess" e o lactato sao ainda considerados como marcadores prognosticos em pacientes com sepse grave ou choque septico reanimados de acordo com o "early goal directed therapy". Outros estudos devem ser realizados com a intencao de demonstrar se intervencoes hemodinâmicas Baseadas no "standard Base Excess" e nos niveis de lactato podem ser uteis em melhorar desfechos clinicos em pacientes com sepse grave ou choque septico.