Lactate Arterial-Central Venous Gradient among COVID-19 Patients in ICU: A Potential Tool in the Clinical Practice.
Journal
Critical care research and practice
ISSN: 2090-1305
Titre abrégé: Crit Care Res Pract
Pays: Egypt
ID NLM: 101539357
Informations de publication
Date de publication:
2020
2020
Historique:
received:
24
04
2020
revised:
16
06
2020
accepted:
03
08
2020
entrez:
5
10
2020
pubmed:
6
10
2020
medline:
6
10
2020
Statut:
epublish
Résumé
In physiological conditions, arterial blood lactate concentration is equal to or lower than central venous blood lactate concentration. A reversal in this rate (i.e., higher lactate concentration in central venous blood), which could reflect a derangement in the mitochondrial metabolism of lung cells induced by inflammation, has been previously reported in patients with ARDS but has been never explored in COVID-19 patients. The aim of this study was to explore if the COVID-19-induced lung cell damage was mirrored by an arterial lactatemia higher than the central venous one; then if the administration of anti-inflammatory therapy (i.e., canakinumab 300 mg subcutaneous) could normalize such abnormal lactate a-cv difference. A prospective cohort study was conducted, started on March 25, 2020, for a duration of 10 days, enrolling 21 patients affected by severe COVID-19 pneumonia undergoing mechanical ventilation consecutively admitted to the ICU of the Rimini Hospital, Italy. Arterial and central venous blood samples were contemporarily collected to calculate the difference between arterial and central venous lactate (Delta a-cv lactate) concentrations within 24 h from tracheal intubation ( At A reversed Delta a-cv lactate might be interpreted as one of the effects of COVID-19-related cytokine storm, which could reflect a derangement in the mitochondrial metabolism of lung cells induced by severe inflammation or other uncoupling mediators. In addition, Delta a-cv lactate decrease might also reflect the anti-inflammatory activity of canakinumab. Our preliminary findings need to be confirmed by larger outcome studies.
Identifiants
pubmed: 33014462
doi: 10.1155/2020/4743904
pmc: PMC7519437
doi:
Types de publication
Journal Article
Langues
eng
Pagination
4743904Informations de copyright
Copyright © 2020 Giuseppe Nardi et al.
Déclaration de conflit d'intérêts
The authors declare that they have no conflicts of interest.
Références
Am J Respir Crit Care Med. 1997 Oct;156(4 Pt 1):1099-104
pubmed: 9351608
Crit Care. 2017 May 12;21(1):105
pubmed: 28499395
J Crit Care. 2017 Aug;40:267-268
pubmed: 28215737
Radiol Med. 2020 May;125(5):461-464
pubmed: 32358691
Sci Rep. 2019 Feb 14;9(1):2108
pubmed: 30765824
Chest. 1997 May;111(5):1301-5
pubmed: 9149587
Anesth Analg. 1993 Dec;77(6):1104-10
pubmed: 8250298
Am J Surg. 1996 Feb;171(2):221-6
pubmed: 8619454
J Am Coll Cardiol. 2018 May 29;71(21):2392-2401
pubmed: 29544870
JAMA. 1993 Dec 22-29;270(24):2957-63
pubmed: 8254858
Crit Care Res Pract. 2010;2010:917053
pubmed: 20981271
Clin Immunol. 2020 May;214:108393
pubmed: 32222466
Crit Care. 2020 Feb 10;24(1):46
pubmed: 32041652
N Engl J Med. 2018 May 17;378(20):1908-1919
pubmed: 29768139
Ann Rheum Dis. 2018 Dec;77(12):1710-1719
pubmed: 30269054
Chest. 2020 Jul;158(1):195-205
pubmed: 32224074
Minerva Anestesiol. 2006 Jun;72(6):597-604
pubmed: 16682934
N Engl J Med. 2017 Sep 21;377(12):1119-1131
pubmed: 28845751
Ann Intern Med. 2003 Jul 15;139(2):137-47
pubmed: 12859163
Microbiol Mol Biol Rev. 2012 Mar;76(1):16-32
pubmed: 22390970