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clinical skills
patient monitoring
respiratory conditions

Pre-hospital lactate monitoring for adults with sepsis

02 September 2014
Features
02 September 2014
Volume 6 · Issue 9

Abstract

Background: Sepsis is a life-threatening condition that claims 37 000 lives in the UK. The sepsis six care bundle was developed by the surviving sepsis campaign in 2002 to address this high mortality rate. Part of this care bundle involves measuring blood lactate which is prognostic of mortality. Lactate can be measured by paramedics in the pre-hospital setting using hand held monitors similar to blood glucose machines, with accuracy that is comparable to laboratory measured lactate.

Method: A focused electronic literature search was carried out on a number of different databases as well as a hand search of specific relevant journals. Data was also obtained from reference harvesting, although the limitations of this was appreciated. Experts in the field were also contacted with relevant data obtained. An ongoing pre-hospital trial monitoring lactate was also identified and these researchers were contacted with relevant data obtained.

Conclusions: Pre-hospital lactate monitoring would promote better recognition of sepsis in adults and improve the quality of care. It could be used to initiate a specific treatment regime such as intravenous antibiotics. This would reduce the numbers of patients admitted to intensive care, helping to reduce mortality and costs for the NHS.

This project began as a piece of academic research for a service improvement project looking at the rationale of monitoring lactate for adults with sepsis in the pre-hospital setting. Paramedics have for some time been at the forefront in contributing to the treatment and improvement in mortality rate of various lifethreatening conditions, such as myocardial infarction and stroke (Small, 2012). The same improvements in patient outcome could be witnessed in sepsis with improved recognition and management (Robson et al, 2009). The proviso for this is that certain aspects of the Sepsis Six screening tool are readily adopted within the prehospital arena (Boardman et al, 2009). However, current pre-hospital sepsis treatment is ad hoc and far from standardised.

Sepsis is a life-threatening condition with estimates of up to 37 000 deaths annually in the UK alone. When sepsis is not treated the mortality rate increases by 8% every hour (Cronshaw et al, 2011). Such patients are very expensive for healthcare systems to manage, with septic patients accounting for 27% of all admissions to intensive care units in England (Small, 2012). Some observers estimate the cost to treat each sepsis patient is between $22 000–$50 000 (Seymour et al, 2010).

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Lactate
Paramedic
Pre-hospital
Sepsis