Presentation Number: P39 Author(s): Simon Eiref, Asaf Gave, Scott Gould, Ezra Gillego, Anita Hariprashad, Shailyn Almonte, Christine Wiest, Michael Leitman, Beth Israel Medical Center Clinical

Author(s):
Simon Eiref, Asaf Gave, Scott Gould, Ezra Gillego, Anita Hariprashad, Shailyn Almonte, Christine Wiest, Michael Leitman, Beth Israel Medical Center

Background: Interest in the application of capillary (CAP) whole blood lactate (LAC) has led to the development of handheld point-of-care devices that use test strip technology similar to glucometers. These devices can process tiny μl aliquots of CAP blood from patient fingersticks, with rapid result turnaround time. As such, the use of CAP blood may have advantages over arterial (ART) blood in LAC determination.

Hypothesis: We hypothesized that changes in CAP LAC trend closely with ART LAC levels in patients undergoing resuscitation for severe sepsis and septic shock.

Methods: The study took place in the surgical ICU of an urban teaching hospital. Fingerstick CAP whole blood specimens were obtained via lancet every 4 – 6 hours, and assessed for LAC using a handheld LAC analyzer (StatStrip, Nova Biomedical, MA). Comparison was made to ART blood specimens that were assessed for LAC both by blood gas analyzer and core lab.

Results: Six patients with severe sepsis (A, B) and septic shock (C, D, E, F) were included from Sep to Oct 2013. The group had an average age 81 years, and mean APACHE II score of 20. Changes in CAP and ART LAC over time are shown for each patient (x-axis = 24-hour clock time, y-axis = LAC mmol/L, blue = CAP LAC, red = ART LAC). Patient A had colitis, B perforated ulcer, C cholangitis, D strangulated hernia, E anastomotic leak, and F pneumonia. CAP and ART LAC trended closely together over time: rising (E, F), peaking (E, F), and falling (A, B, C, D, F) in tandem. Resolution of elevated CAP and ART LAC levels mirrored clinical improvement. High LAC normalized in all cases except for patient E, who did not recover.

Conclusions: Fingerstick CAP LAC trends closely with ART LAC in patients undergoing resuscitation for severe sepsis and septic shock – suggesting a new guide for goal-directed therapy.