Mildly elevated lactate levels are associated with microcirculatory flow abnormalities and increased mortality: a microSOAP post hoc analysis

This is the final version. Available on open access from BMC via the DOI in this recordBACKGROUND: Mildly elevated lactate levels (i.e., 1-2 mmol/L) are increasingly recognized as a prognostic finding in critically ill patients. One of several possible underlying mechanisms, microcirculatory dysfunction, can be assessed at the bedside using sublingual direct in vivo microscopy. We aimed to evaluate the association between relative hyperlactatemia, microcirculatory flow, and outcome. METHODS: This study was a predefined subanalysis of a multicenter international point prevalence study on microcirculatory flow abnormalities, the Microcirculatory Shock Occurrence in Acutely ill Patients (microSOAP). Microcirculatory flow abnormalities were assessed with sidestream dark-field imaging. Abnormal microcirculatory flow was defined as a microvascular flow index (MFI)  1.5 mmol/L was independently associated with a MFI < 2.6 (OR 2.5, 95% CI 1.1-5.7, P = 0.027). CONCLUSIONS: In a heterogeneous ICU population, a single-spot mildly elevated lactate level (even within the reference range) was independently associated with increased mortality and microvascular flow abnormalities. In vivo microscopy of the microcirculation may be helpful in discriminating between flow- and non-flow-related causes of mildly elevated lactate levels. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01179243 . Registered on August 3, 2010

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Predisposição ao uso e abuso de álcool entre estudantes de graduação em enfermagem da UFRN La predisposición al uso y abuso de alcohol entre estudiantes de graduación en enfermería de la UFRN Predisposition to the use and abuse of alcohol among students of graduation in nursing of UFRN

Estudo de natureza exploratória descritiva com abordagem quantitativa, avaliou a predisposição para o uso e abuso do álcool na Graduação em Enfermagem/UFRN. A amostra foi composta por 42 alunos regularmente matriculados, sendo 76% do gênero feminino. Utilizou-se o questionário CAGE acrescido de itens sobre a síndrome da abstinência alcoólica. Metade (50%) faz uso de álcool, com idade entre 21 e 22 anos (41%). O maior consumo está no quinto período (38%), seguido do terceiro (19%). Dentre os pesquisados, 34% sentem-se fisicamente mal após beberem, 33% tropeçam, cambaleiam e trançam as pernas, e 33% sentem calor e suam. No que se refere aos sintomas mentais e emocionais, 50% referiram lentidão do raciocínio, 25% sensações estranhas e assustadoras quando bebem, e 25%, perda da memória. Conclui-se que há predisposição para o uso e abuso do álcool, e uma tendência ao alcoolismo feminino.<br>El estudio de naturaleza exploratoria descriptiva con el acercamiento cuantitativo, evalu�� la predisposición para el uso y abuso del alcoholen la Graduación en enfermería /UFRN. La muestra estaba regularmente compuesta por 42 estudiantes se enrollados, mientras siendo 76% del género femenino. La CAGE investigación se usó agregada de artículos enel síndrome de la abstinencia alcohólica. Medio (50%) hace uso de alcohol, con la edad entre 21 a 22 años (41%). El consumo más grande está en el quinto período (38%), siguiendo por la tercera período (19%) entre los investigó, 34% se sentían males físicamente después de haber bebido, 33% viaje, oscilación y trenza las piernas, y 33% se sentían calientes y sudor. En lo que se refiere a los síntomas mentales y emocionales, 50% se refirieron lentitud del razonamiento, 25% sensaciones extrañas y aterradoras cuando ellos beben, y 25% pérdida de la memoria. Se acabó que hay predisposición para el uso y abuso del alcohol, y una tendencia al alcoholismo femenino.<br>Study of descriptive exploratory nature with quantitative approach, evaluated the predisposition for the use and abuse of the alcohol in the Graduation in Nursing/UFRN. The sample was composed by 42 students regularly enrolled, being 76% of the feminine gender. The CAGE questionnaire was used added of items on the syndrome of the alcoholic abstinence. Half (50%) makes use of alcohol, with age among 21 to 22 years (41%). The largest consumption is in the fifth period (38%), following by the third period (19%) among researched them, 34% felt bad physically after having drunk, 33% trip, sway and braid the legs, and33% felt hot and sweat. In what refers to the mental and emotional symptoms, 50% referred slowness of the reasoning, 25% strange and frightening sensations when they drink, and 25% loss of the memory. It was ended that there is predisposition for the use and abuse of the alcohol and a tendency to the feminine alcoholism