Browsing by Author "Warakarn Wilachone"

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    Correlation of arterial, central venous and capillary lactate levels in septic shock patients.
    (2011-02-01) Pattharawin Pattharanitima; Surat Tongyoo; Ranistha Ratanarat; Warakarn Wilachone; Aekarin Poompichet; Chairat Permpikul; Mahidol University
    Blood lactate level increases in response to tissue hypoxia and this level is currently used to monitor shock management. To obtain the arterial lactate value in clinical practice is a time consuming process. Our previous study demonstrated good correlation between the capillary lactate determined by a portable lactate analyzer and the standard arterial lactate in critically ill patients. This study was aimed to examine the uses of this capillary lactate in septic shock. A prospective comparison of arterial, venous and capillary lactate level from septic shock patients admitted in the general wards and the Medical ICU, Department of Medicine, Siriraj hospital was performed during October 2009 to February 2010. Thirty patients were included in the study. The mean age was 66 (24-86) years and 16 (53%) were female. The correlation between arterial and central venous was 0.992 and the correlation between arterial and capillary lactate level was 0.945 (p = 0.01 in both comparisons). In addition, there was certain agreement between the arterial and the capillary lactate especially when arterial lactate was below 10 mmol/L. The capillary lactate level determined by the portable lactate analyzer (Accutrend Plus) correlated well with arterial lactate level. This method, when used cautiously, may be used to monitor septic shock treatment as an alternative to the standard arterial lactate determination.
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    Impact of septic shock hemodynamic resuscitation guidelines on rapid early volume replacement and reduced M
    (2010-12-01) Chairat Permpikul; Surat Tongyoo; Ranistha Ratanarat; Warakarn Wilachone; Aekarin Poompichet; Mahidol University
    Background: Septic shock is one of the most serious conditions associated with high mortality. We recently developed a modified septic shock management guideline focusing on rapid restoration of hemodynamics by using clinical endpoint. Our aim was to analyze patients' outcomes following the guideline implementation. Material and Method: A retrospective review of hemodynamic data sheet and clinical outcomes of patients admitted to medical ICU and medical Wards and during June 2004 and February 2006. Results: One hundred and four patients' records were retrieved. The patients' mean age was 62.5 ± 18.6 year. Their mean APACHE II score were 24.9 ± 6.7 and the overall mortality was 59%. Sixty eight patients (65.4%) underwent guideline directed therapy (guideline group). The guideline group received higher volume resuscitation from the first hour of resuscitation (1,016.3 ± 675.0 ml vs. 521.4 ± 359.2 ml, p < 0.001) to the forty eighth hour (10,096.9 ± 3,256.1 ml vs. 8,067.3 ± 2,591.9 ml, p = 0.006). More of them achieved the therapeutic goal within 6 hours (86.8% vs. 44.4%, p < 0.001) and their hospital mortality was lower (41.2% vs. 69.4%, p = 0.008). When analyzing differences between those who survived and those who died, more of the surviving patients underwent guideline directed treatment (79.5% vs. 55%, p = 0.012). They received higher volume replacement from the first hour to the end of the twelfth hour (first hour 1,098.0 ± 723.0 vs. 660.9 ± 478.9 ml, p < 0.001; the end of the twelfth hour 3,746.6 ± 1,799 vs. 3,014.1 ± 1,579.9 ml, p = 0.038) and more of them achieved the therapeutic goal within 6 hours (95.5% vs. 55%, p < 0.001). Multivariate analysis of factors associated with mortality disclosed APACHE II score, volume resuscitation more than 800 ml in the first hour and achievement of the therapeutic goal within 6 hours. Conclusion: Implementation of our modified septic shock guideline is associated with rapid initial volume replacement, prompt achievement of therapeutic goal and improved outcomes. Volume resuscitation greater than 800 ml in the first hour is associated with better survival.