Year: 2009
Type: dissertation
Study design: Case Report
Abstract: The resident internal medicine called from the Emergency Department \n(ED). “Can you please come and see my patient, I think he is \nbecoming septic and needs admission to the intensive care”. In the \nED we found a confused older patient with an oxygen mask who \nwas clearly dyspnoeic, the urinary catheter was filled with a dark \nbrown fluid, the collecting bag was empty. The resident reported \nthat he admitted the patient 4 hours earlier as he suspected pneumonia. \nOn admission the patient was hypoxic but this clearly improved \nwith the supplemental oxygen. The resident was still waiting \nfor all the laboratory results and the chest X-ray. However, now that \nthe patient had developed hypotension he thought the patient was \nclearly at risk and intensive care admission was required. When we \nasked why he had not called us earlier, he replied that he intended \nto admit the patient to the general ward as he was haemodynamically \nstable and oxygenation had improved on supplemental oxygen \nso intensive care admission was not required. When reviewing \nthe blood sample that was drawn 30 min following presentation, \nbesides hypoxaemia, an increased lactate level of 4.6 mmol/l was \npresent. The resident pointed out that hyperlactataemia in sepsis \nis not related to tissue hypoxia but rather is a marker of increased \naerobic metabolism. Therefore he thought there was no need to \nreact to this hyperlactataemia. \nIn this case presentation the presence of hyperlactataemia did not \nresult in treatment consequences. When having read this thesis the \nreader should be able to indicate whether the resident was right or \nwrong in this decision. \nThe general aim of this thesis is to evaluate the clinical value of \nblood lactate monitoring by assessing various aspects of lactate \nmonitoring, including aetiology, the prognostic value and the impact \non clinical outcome when incorporating lactate measurement in a treatment algorithm at the bedside. As the process of obtaining \ninformed consent for participation in research is challenging in intensive \ncare patients due to the emergency nature of critical illness, \nthe secondary aim of this thesis is to evaluate consent procedures in \nemergency critical care research.
Author: Tim C. Jansen
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2127640692