J Korean Surg Soc.  2011 Feb;80(2):84-89. 10.4174/jkss.2011.80.2.84.

Serum Lactate and Base Deficit: Early Predictors of Morbidity and Mortality in Burn Patients with Inhalation Injury

• Cho YS
• Yang HT
• Yim H
• Kim D
• Hur J
• Kim JH
• Chun W

• KMID: 2117114
• DOI: http://doi.org/10.4174/jkss.2011.80.2.84

Abstract

PURPOSE
The aim of this study was to elucidate whether plasma lactate (PL) and base deficit (BD) are useful early parameters to predict the prognosis of burn patients with inhalation injury. In addition, one of the main objectives was to evaluate if PL and its change, BD and its change due to fluid resuscitation, adds additional information.
METHODS
A retrospective review was performed on 151 patients admitted to our burn intensive care unit who were suspected to have inhalation burn injury, and then were confirmed by fibreoptic bronchoscopy between 1 Jan 2008 and 31 Dec 2008. All patients received proper fluid and electrolyte resuscitation, pain management, nutritional support, wound care and surgical debridement of dead tissue by burn surgeon.
RESULTS
Initial PL, PL1 (24 hours later) and initial BD show statistical differences between survivors group and non-survivors group. A better chance of survival occurs when resuscitation results in normal PL values within 24 h. Moreover, an outcome predictor of shock and effective resuscitation could be defined by evaluating the changes of BD on Day 1. Normalization of the BD within 24 h is associated with a better chance of survival.
CONCLUSION
Measuring PL, BD and their changes may help to identify burn patients either for adequacy of treatment, or selection of other therapeutic options. Therefore titration of burn resuscitation to normalize PL and BD levels may be a reasonable method to improve burn mortality.

Keyword

Burn; Plasma lactate (PL); Base deficit (BD)

MeSH Terms

Bronchoscopy
Burns
Burns, Inhalation
Debridement
Humans
Inhalation
Intensive Care Units
Lactic Acid
Nutritional Support
Pain Management
Plasma
Prognosis
Resuscitation
Retrospective Studies
Shock
Survivors
Lactic Acid

Reference

References

1. Ishihara H, Otomo N, Suzuki A, Takamura K, Tsubo T, Matsuki A. Detection of capillary protein leakage by glucose and indocyanine green dilutions during the early post-burn period. Burns. 1998; 24:525–31.

2. Saffle JR. The phenomenon of “fluid creep” in acute burn resuscitation. J Burn Care Res. 2007; 28:382–95.

3. Germann G, Steinau HU. Current aspects of burn treatment. Zentralbl Chir. 1993; 118:290–302.

4. Herndon DN, Hilton JG, Traber DL, Barrow RE. Burn shock and its resuscitation. Prog Clin Biol Res. 1987; 236A:539–57.

5. Husain FA, Martin MJ, Mullenix PS, Steele SR, Elliott DC. Serum lactate and base deficit as predictors of mortality and morbidity. Am J Surg. 2003; 185:485–91.

6. Vincent JL, Dufaye P, Berre J, Leeman M, Degaute JP, Kahn RJ. Serial lactate determinations during circulatory shock. Crit Care Med. 1983; 11:449–51.

7. McNelis J, Marini CP, Jurkiewicz A, Szomstein S, Simms HH, Ritter G, et al. Prolonged lactate clearance is associated with increased mortality in the surgical intensive care unit. Am J Surg. 2001; 182:481–5.

8. Kamolz LP, Andel H, Schramm W, Meissl G, Herndon DN, Frey M. Lactate: early predictor of morbidity and mortality in patients with severe burns. Burns. 2005; 31:986–90.

9. Jeng JG, Jablonski K, Bridgeman A, Jordan MH. Serum lactate, not base deficit, rapidly predicts survival after major burns. Burns. 2002; 28:161–6.

10. Mikulaschek A, Henry SM, Donovan R, Scalea TM. Serum lactate is not predicted by anion gap or base escess after trauma resuscitation. J trauma. 1996; 40:218.

11. Bakker J, Coffernils M, Leon M, Gris P, Vincent JL. Blood lactate levels are superior to oxygen-derived variables in predicting outcome in human septic shock. Chest. 1991; 99:956.

12. Vincent JL. Endpoints of resuscitation: arterial blood pressure, oxygen delivery, blood lactate, or …? Intensive Care Med. 1996; 22:3.

13. Allison PD. Survival analysis using the SAS^Ⓡ system: a practical guide. Cary, NC: The SAS Institute Inc.;1995.

14. Shires GT, Black EA. Second conference on supportive therapy in burn care. J Trauma. 1981; 21:665.

15. Rutherford EJ, Morris JA, Reed GW, Hall KS. Base deficit stratifies mortality and determines therapy. J Trauma. 1992; 33:417.

16. Abramson D, Scalea TM, Hitchcock R, Trooskin SZ, Henry SM, Greenspan J. Lactate clearance and survival following injury. J Trauma. 1993; 35:584.

17. Cowan BN, Burn HJG, Boyle P, Ledingham IMA. The relative prognostic value of lactate and hemodynamic measurements in early shock. Anaesthesia. 1984; 39:750.

18. Wo CC, Shoemaker WC, Apple PL, Bishop MH, Kram HB, Hardin E. Unreliability of blood pressure and heart rate to evaluate cardiac output in emergency resuscitation and critical illness. Crit Care Med. 1993; 21:218–23.

19. Sambol JT, White J, Horton JW, Deitch EA. Burn-induced impairment of cardiac contractile function is due to gut-derived factors transported in mesenteric lymph. Shock. 2002; 18:272–6.

20. Porter JM, Ivatury RR. In search of the optimal end points of resuscitation in trauma patients: a review. J Trauma. 1998; 44:908–14.

21. Andel D, Kamolz LP, Roka J, Schramm W, Zimpfer M, Frey M, et al. Base deficit and lactate: Early predictors of morbidity and mortality in patients with burns. Burns. 2007; 33:973–8.

22. Weil MH, Afifi AA. Experimental and clinical studies on lactate and pyruvate as indicators of the severity of acute circulatory failure (shock). Circulation. 1970; 41:989–1001.

23. Groeneveld ABJ, Kester ADM. Relation of arterial blood lactate to oxygen delivery and hemodynamic variables in human shock states. Circ Shock. 1987; 22:35–53.

24. Marecaux G, Pinsky MR, Dupont E, Kahn RJ, Vincent JL. Blood lactate levels are better prognostic indicators than TNF and IL-6 levels in patients with septic shock 1987. Intensive Care Med. 1996; 22:404–8.

25. Waisman Y, Eichacker PQ, Banks SM, Hoffman WD, MacVittie TJ, Natanson C. Acute hemorrhage in dogs: construction and validation of medels to quantify blood loss. J Appl Physiol. 1993; 74:510–9.

26. Kaplan LJ, Kellum JA. Initial pH, base deficit, lactate, anion gap, strong ion difference, and strong ion gap predict outcome from major vascular injury. Crit Care Med. 2004; 32:1120–4.

27. Baxter CR. Problems and complication of burn shock resuscitation. Surg Clin North Am. 1978; 58:1313.

28. Smith DL, Cairns BA, Ramadan F, Dalston JS, Fakhry SM, Rutledge R, et al. Effect of inhalation injury, burn size, and age on mortality: a study of 1447 consecutive burn patients. J Trauma. 1994; 37:655–9.

29. Shirani KZ, Pruitt Jr BA, Mason Jr AD. The influence of inhalation injury and pneumonia on burn mortality. Ann Surg. 1987; 205:82–7.

30. Tredget EE, Shankowsky HA, Taerum TV, Moysa GL, Alton JD. The role of inhalation injury in burn trauma. A Canadian experience. Ann Surg. 1990; 212:720–7.