![]() ![]() © British Journal of General Practice 2017. General practice lactate point-of-care testing pre-hospital care primary health care sepsis. RCT evidence from community settings is needed to evaluate this potentially beneficial diagnostic technology. There are no randomised controlled trials (RCTs) and no studies in primary care. ![]() This review identifies an evidence gap - there is no high-quality evidence to support the use of point-of-care lactate in community settings. Two studies demonstrated a significant reduction in time to treatment for antibiotics and intravenous fluids. One study demonstrated a significant reduction in length of hospital stay, although another did not find any significant difference. We observed a reliable analytical performance of the POCT (CVs < 3.8 for repeatability and <5.0 for reproducibility) an excellent correlation between POCT and central laboratory analysers (R 2: 0.96-0.98, slopes:0.83-0.90, intercepts: 0.02-0.03) and an excellent concordance of the POCT results to the central laboratory analyser results (98-100). Five studies demonstrated a trend towards reduced mortality with point-of-care lactate three studies achieved statistical significance. Seven studies were recruited from emergency departments, and one from a pre-hospital aeromedical setting. Quality assessment for observational studies was performed using the ROBINS-I tool.Įight studies were eligible for inclusion (3063 patients). Two independent authors screened 3063 records for eligibility, and extracted data from eligible studies. Studies comparing the use of point-of-care lactate to usual care in initial patient assessment at presentation to health care were identified using a maximally sensitive search strategy of six electronic databases. To investigate the effect of using point-of-care lactate at presentation to health care on mortality and other clinical outcomes, in patients presenting with acute infections. However, there has been little research into its utility in these environments. Keywords: acidosis elevated anion gap hyperlactatemia lactate lactic acid point of care. Point-of-care technology could facilitate measurement of lactate by clinicians in the community. Point of care analyzers such as the Lactate Pro, Lactate Scout, Accutrend, iSTAT, and Lactate Plus have been shown to be accurate lactate measurement instruments in small animal patients. The negative bias in i-STAT and Radiometer results may confound the interpretation of patient condition if multiple methods are used within the same institution.Lactate is measured in hospital settings to identify patients with sepsis and severe infections, and to guide initiation of early treatment. The Nova analyzer reported higher lactate results than either the Vitros or Integra. At high (>54.1 mg/dL ) lactate values, the Radiometer and i-STAT methods reported lower lactate results compared with the Vitros and Integra. Correlation between lactate methods was good with slopes between 0.87 and 1.06 and intercepts of 0.9 to 1.8 mg/dL (0.1-0.2 mmol/L) of lactate for all 4 methods compared with the Vitros. ![]() Results were compared by least squares regression and Bland-Altmann plots and by comparing concordance within clinically relevant lactate ranges. The Vitros LAC slide assay was used as the reference method. We compared 3 whole blood lactate methods (Radiometer ABL 725, Radiometer Medical A/S, Bronshoj, Denmark i-STAT, i-STAT, East Windsor, NJ and Nova Lactate Plus, Nova Biomedical, Waltham, MA) with 2 plasma-based methods (Roche Integra, Roche Diagnostics, Indianapolis, IN and Vitros, Ortho Clinical Diagnostics, Rochester, NY). Measurement of lactate levels is important in the care of critically ill adult and pediatric patients. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |