Assessing the discriminative ability of the respiratory exchange ratio to detect hyperlactatemia during intermediate-to-high risk abdominal surgery
Abstract Background A mismatch between oxygen delivery (DO2) and consumption (VO2) is associated with increased perioperative morbidity and mortality. Hyperlactatemia is often used as an early screening tool, but this non-continuous measurement requires intermittent arterial line sampling. Having a...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-07-01
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| Series: | BMC Anesthesiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12871-022-01757-8 |
| _version_ | 1818158310086410240 |
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| author | Lydia Karam Olivier Desebbe Sean Coeckelenbergh Brenton Alexander Nicolas Colombo Edita Laukaityte Hung Pham Marc Lanteri Minet Leila Toubal Maya Moussa Salima Naili Jacques Duranteau Jean-Louis Vincent Philippe Van der Linden Alexandre Joosten |
| author_facet | Lydia Karam Olivier Desebbe Sean Coeckelenbergh Brenton Alexander Nicolas Colombo Edita Laukaityte Hung Pham Marc Lanteri Minet Leila Toubal Maya Moussa Salima Naili Jacques Duranteau Jean-Louis Vincent Philippe Van der Linden Alexandre Joosten |
| author_sort | Lydia Karam |
| collection | DOAJ |
| description | Abstract Background A mismatch between oxygen delivery (DO2) and consumption (VO2) is associated with increased perioperative morbidity and mortality. Hyperlactatemia is often used as an early screening tool, but this non-continuous measurement requires intermittent arterial line sampling. Having a non-invasive tool to rapidly detect inadequate DO2 is of great clinical relevance. The respiratory exchange ratio (RER) can be easily measured in all intubated patients and has been shown to predict postoperative complications. We therefore aimed to assess the discriminative ability of the RER to detect an inadequate DO2 as reflected by hyperlactatemia in patients having intermediate-to-high risk abdominal surgery. Methods This historical cohort study included all consecutive patients who underwent intermediate-to-high risk surgery from January 1st, 2014, to April 30th, 2019 except those who did not have RER and/or arterial lactate measured. Blood lactate levels were measured routinely at the beginning and end of surgery and RER was calculated at the same moment as the blood gas sampling. The present study tested the hypothesis that RER measured at the end of surgery could detect hyperlactatemia at that time. A receiver operating characteristic (ROC) curve was constructed to assess if RER calculated at the end of the surgery could detect hyperlactatemia. The chosen RER threshold corresponded to the highest value of the sum of the specificity and the sensitivity (Youden Index). Results Among the 996 patients available in our study cohort, 941 were included and analyzed. The area under the ROC curve was 0.73 (95% CI: 0.70 to 0.76; p < 0.001), with a RER threshold of 0.75, allowing to discriminate a lactate > 1.5 mmol/L with a sensitivity of 87.5% and a specificity of 49.5%. Conclusion In mechanically ventilated patients undergoing intermediate to high-risk abdominal surgery, the RER had moderate discriminative abilities to detect hyperlactatemia. Increased values should prompt clinicians to investigate for the presence of hyperlactatemia and treat any potential causes of DO2/VO2 mismatch as suggested by the subsequent presence of hyperlactatemia. |
| first_indexed | 2024-12-11T15:28:03Z |
| format | Article |
| id | doaj.art-85fed9a7809247858bdbdc6714c3c7e4 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-12-11T15:28:03Z |
| publishDate | 2022-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-85fed9a7809247858bdbdc6714c3c7e42022-12-22T01:00:09ZengBMCBMC Anesthesiology1471-22532022-07-012211810.1186/s12871-022-01757-8Assessing the discriminative ability of the respiratory exchange ratio to detect hyperlactatemia during intermediate-to-high risk abdominal surgeryLydia Karam0Olivier Desebbe1Sean Coeckelenbergh2Brenton Alexander3Nicolas Colombo4Edita Laukaityte5Hung Pham6Marc Lanteri Minet7Leila Toubal8Maya Moussa9Salima Naili10Jacques Duranteau11Jean-Louis Vincent12Philippe Van der Linden13Alexandre Joosten14Department of Anesthesiology and Intensive Care, Université Paris-Saclay, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris (APHP)Department of Anesthesiology and Perioperative Medicine Sauvegarde ClinicDepartment of Anesthesiology and Intensive Care, Université Paris-Saclay, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris (APHP)Department of Anesthesiology, University of California San DiegoDepartment of Anesthesiology, Paul Brousse HospitalDepartment of Anesthesiology and Intensive Care, Université Paris-Saclay, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris (APHP)Department of Anesthesiology and Intensive Care, Université Paris-Saclay, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris (APHP)Department of Anesthesiology and Intensive Care, Université Paris-Saclay, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris (APHP)Department of Anesthesiology and Intensive Care, Université Paris-Saclay, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris (APHP)Department of Anesthesiology and Intensive Care, Université Paris-Saclay, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris (APHP)Department of Anesthesiology and Intensive Care, Université Paris-Saclay, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris (APHP)Department of Anesthesiology and Intensive Care, Université Paris-Saclay, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris (APHP)Department of Intensive Care, Erasme Hospital, Université Libre de BruxellesDepartment of Anesthesiology, Brugmann Hospital, Université Libre de BruxellesDepartment of Anesthesiology and Intensive Care, Université Paris-Saclay, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris (APHP)Abstract Background A mismatch between oxygen delivery (DO2) and consumption (VO2) is associated with increased perioperative morbidity and mortality. Hyperlactatemia is often used as an early screening tool, but this non-continuous measurement requires intermittent arterial line sampling. Having a non-invasive tool to rapidly detect inadequate DO2 is of great clinical relevance. The respiratory exchange ratio (RER) can be easily measured in all intubated patients and has been shown to predict postoperative complications. We therefore aimed to assess the discriminative ability of the RER to detect an inadequate DO2 as reflected by hyperlactatemia in patients having intermediate-to-high risk abdominal surgery. Methods This historical cohort study included all consecutive patients who underwent intermediate-to-high risk surgery from January 1st, 2014, to April 30th, 2019 except those who did not have RER and/or arterial lactate measured. Blood lactate levels were measured routinely at the beginning and end of surgery and RER was calculated at the same moment as the blood gas sampling. The present study tested the hypothesis that RER measured at the end of surgery could detect hyperlactatemia at that time. A receiver operating characteristic (ROC) curve was constructed to assess if RER calculated at the end of the surgery could detect hyperlactatemia. The chosen RER threshold corresponded to the highest value of the sum of the specificity and the sensitivity (Youden Index). Results Among the 996 patients available in our study cohort, 941 were included and analyzed. The area under the ROC curve was 0.73 (95% CI: 0.70 to 0.76; p < 0.001), with a RER threshold of 0.75, allowing to discriminate a lactate > 1.5 mmol/L with a sensitivity of 87.5% and a specificity of 49.5%. Conclusion In mechanically ventilated patients undergoing intermediate to high-risk abdominal surgery, the RER had moderate discriminative abilities to detect hyperlactatemia. Increased values should prompt clinicians to investigate for the presence of hyperlactatemia and treat any potential causes of DO2/VO2 mismatch as suggested by the subsequent presence of hyperlactatemia.https://doi.org/10.1186/s12871-022-01757-8Tissue hypoxiaAnaerobic metabolismShockGoal-directed hemodynamic therapy |
| spellingShingle | Lydia Karam Olivier Desebbe Sean Coeckelenbergh Brenton Alexander Nicolas Colombo Edita Laukaityte Hung Pham Marc Lanteri Minet Leila Toubal Maya Moussa Salima Naili Jacques Duranteau Jean-Louis Vincent Philippe Van der Linden Alexandre Joosten Assessing the discriminative ability of the respiratory exchange ratio to detect hyperlactatemia during intermediate-to-high risk abdominal surgery BMC Anesthesiology Tissue hypoxia Anaerobic metabolism Shock Goal-directed hemodynamic therapy |
| title | Assessing the discriminative ability of the respiratory exchange ratio to detect hyperlactatemia during intermediate-to-high risk abdominal surgery |
| title_full | Assessing the discriminative ability of the respiratory exchange ratio to detect hyperlactatemia during intermediate-to-high risk abdominal surgery |
| title_fullStr | Assessing the discriminative ability of the respiratory exchange ratio to detect hyperlactatemia during intermediate-to-high risk abdominal surgery |
| title_full_unstemmed | Assessing the discriminative ability of the respiratory exchange ratio to detect hyperlactatemia during intermediate-to-high risk abdominal surgery |
| title_short | Assessing the discriminative ability of the respiratory exchange ratio to detect hyperlactatemia during intermediate-to-high risk abdominal surgery |
| title_sort | assessing the discriminative ability of the respiratory exchange ratio to detect hyperlactatemia during intermediate to high risk abdominal surgery |
| topic | Tissue hypoxia Anaerobic metabolism Shock Goal-directed hemodynamic therapy |
| url | https://doi.org/10.1186/s12871-022-01757-8 |
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