References
Pre-hospital lactate testing in the recognition and management of sepsis and septic shock
Abstract
Sepsis a common condition, with a high mortality rate. Patients with this condition are routinely encountered by ambulance clinicians, but recognition of septic shock can be challenging. The pre-hospital phase of sepsis care provides the earliest opportunity for identification and treatment. Lactate measurement is a tool commonly used to stratify patient illness severity in sepsis, and is recommended as part of initial management in the acute hospital setting. A lack of evidence to inform the pre-hospital phase of care for patients with suspected sepsis prompted this pragmatic evaluation of point of care lactate measurement in an ambulance service. It is important to highlight that this study was carried out prior to the 2016 Sepsis-3 definitions and quickSOFA clinical criteria for recognising sepsis.
Every 3 seconds, somebody in the World dies from sepsis (Hall et al, 2011), and with research suggesting sepsis has a mortality rate 5–6 times higher than acute coronary syndrome or stroke (Daniels, 2011), it is easy to see why sepsis is one of the leading causes of death in the World (McPherson et al, 2013). There is a multitude of reasons for the high mortality of sepsis (Martin, 2012); however, it appears poor recognition and delays to antimicrobial therapy remain the biggest factors (Puskarich et al, 2011).
The UK Sepsis Trust has published guidelines based on contemporary evidence relating to the early recognition and management of sepsis. These guidelines highlight the importance of obtaining serial lactate as part of the sepsis six (Daniels, 2011). Obtaining an early lactate value allows the clinician to stratify the risk to the patient; this is of particular value in sepsis where cryptic shock is prevalent, meaning blood pressure may be an unreliable means of measuring hypoperfusion (Kirby, 2013). Cryptic shock is where patients in septic shock have global tissue hypoxia, but maintain normotension (Puskarich, 2011). Previous literature reviews have highlighted the paucity of research in the pre-hospital field evaluating point-of-care (POC) lactate testing (McClelland et al, 2012; Kirby, 2013; Charlton, 2014). A lack of evidence to inform the pre-hospital phase of care for patients with suspected sepsis prompted this evaluation of POC lactate measurement in an ambulance service.
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