Pre-hospital lactate testing in the identification of patients with sepsis: a review of the literature

06 December 2013
Volume 5 · Issue 12

Abstract

Sepsis is increasingly common and has a high mortality rate. Sepsis can be difficult to identify and patients with severe sepsis often initially present to the ambulance service. Lactate testing has been utilised successfully in other healthcare settings to assist with the identification of septic patients and stratification of illness severity.

A focused literature review has revealed that pre-hospital lactate testing has shown benefits to clinicians pre-hospitally in the identification of septic patients presenting to the ambulance service. Only four pieces of primary research were identified and small sample sizes and variability of lactate testing limit the generalisation of the findings. Further research is required to fully investigate the potential benefits of using pre-hospital lactate testing to identify those patients with sepsis, severe sepsis and septic shock presenting to the ambulance service.

Sepsis is defined as a clinical syndrome characterised by the presence of both infection and a systemic inflammatory response. Sepsis may result in organ dysfunction, shock and death (Harrison et al, 2006; Wang et al, 2010). The definition of severe sepsis is sepsisinduced organ dysfunction or tissue hypoperfusion, and septic shock is defined by severe sepsis plus hypotension that persists despite fluid resuscitation (Levy et al, 2003; Dellinger et al, 2008).

Severe sepsis is common, and has an estimated incidence of one to three cases per 1 000 population per year, with a rate that has been increasing over two decades (Seymour et al, 2010). Severe sepsis accounts for 27% of admissions to intensive care units (ICU) in England, Wales and Northern Ireland. Patients with severe sepsis account for 46% of all ICU bed days, with a median hospital stay of four weeks. Mortality in patients with severe sepsis remains high at 30–50% (Harrison et al, 2006).

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