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Master Thesis

Lactates veineux et artériels périphériques aux urgences : étude comparative descriptive, rétrospective, monocentrique au sein des urgences de l'Hôpital d'Instruction des Armées Robert Picqué

Abstract : Background: lactate measurement is a useful part of the initial assessment and management of patients in emergency departments (ED) and intensive care units (ICU) in various cases. Arterial blood is considered as the gold standard for lactate measurement. In saying this, there is increasing use of peripheral venous blood for initial assessment of lactate concentration in ED. The aim of our study was to evaluate the agreement between arterial and peripheral venous lactate and secondly between lactate levels, patients outcomes and assessment scores (ASAPS and SAPS II). Methods: our retrospective cohort study conducted in a french ED of a military hospital included 73 patients who had both arterial and peripheral venous lactate measurements. Bland-Altman plots were used to evaluate agreement between lactate measurements. The Wilcoxon rank-sum test was used for secondary objectives. Results: our data showed little agreement between arterial and peripheral venous lactate, with an mean difference of 0,71 mmol/L (CI [0.42; 1.01]) and limits of agreement of -1.74 [-2.24; -2.24] and 3.17 [2.67; 3.67] mmol/L. Differences between measurements also increased with higher lactate levels (called homoscedasticity). There was none significant result with secondary objectives. Conclusion: our study was similar to others comparisons concerning the mean difference and homoscedasticity, but there were many biases that could be avoided by a prospective study looking for a better agreement. Blood lactate testing is now a routine in ED, but its prognostic value is different from one diagnostic category to the other. It remains important to merge it with the rest of clinical evaluation.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03389027
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Submitted on : Wednesday, October 20, 2021 - 6:16:50 PM
Last modification on : Wednesday, December 1, 2021 - 3:48:17 AM
Long-term archiving on: : Friday, January 21, 2022 - 8:33:17 PM

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Jules Dubois. Lactates veineux et artériels périphériques aux urgences : étude comparative descriptive, rétrospective, monocentrique au sein des urgences de l'Hôpital d'Instruction des Armées Robert Picqué. Médecine humaine et pathologie. 2021. ⟨dumas-03389027⟩

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