Lactic acidosis is associated with multiple organ failure and need for ventilator support in patients with severe hemorrhage from trauma.

PURPOSE: Lactate is a biomarker for hypoperfusion and subsequent resuscitation in trauma. It is also a predictor of mortality, but few studies have correlated lactate levels with relevant morbidities after trauma. METHODS: A retrospective review was performed of severely injured trauma patients entered into the Trauma Registry of the German Society for Trauma Surgery (TR-DGU) between 2002 and 2008. Adults requiring intensive care were categorized into two groups: lactate and no lactate. The lactate group had three subgroups: normal, elevated, and high lactate. Mean multiple organ failure (MOF) rates and composite endpoint of time (days) to complete organ failure resolution (CTCOFR) for 14 and 21 days and ventilator-free days (VFD) were compared, as well as other endpoints. RESULTS: We analyzed 2,949 patients, of which 1,199 had lactate measurements. The percentage of patients with MOF increased in each higher lactate subgroup (p < 0.001), as did the mean CTCOFR14 and CTCOFR21 scores (p < 0.001 and < 0.001, respectively). Conversely, the mean VFD decreased in each higher lactate subgroup (p < 0.001). Thus, patients in the elevated and high lactate subgroups had greater MOF rates; required more days, on average, to resolve organ failure; and required more days of ventilator support than patients in the normal lactate subgroup. CONCLUSION: Elevated blood lactate levels from trauma were closely correlated with worse outcomes. Thus, lactate shows promise as a biomarker for resuscitation as well as a predictor of mortality. Furthermore, this study supports its use in critical care trials as an outcome measure.

Effects of desmopressin on platelet membrane glycoproteins and platelet aggregation in volunteers on clopidogrel.

PURPOSE: The use of clopidogrel is standard in interventional cardiology. Haemorrhage occurs in some patients, which implies a need for a non-transfusional therapy. Desmopressin showed its efficacy as an antidote of acetylsalicylic acid. In this trial the effects of desmopressin on platelet glycoproteins and the platelet's ability to aggregate under the influence of clopidogrel are studied. METHODS: The trial was conducted as an open, prospective, single-centre, randomised pilot study with n=17 healthy volunteers in a parallel-group design. 1 h after an oral loading dose of 375 mg clopidogrel the effects of a single-dose of 300 mug of Octostim nasal spray (n=9) on platelet aggregation, activity of platelets on the density of membrane-bound receptors are measured. RESULTS: Ristocetin cofactor and platelet reactivity rose significantly after the administration of Octostim nasal spray with 31.9% and 5.3%, respectively (p=0.0329; p=0.0414). The ADP-induced platelet aggregation increased after the administration of Octostim nasal spray by approximately 20% (p=0.0564). The fraction of CD62- and CD63-positive platelets did not change after clopidogrel nor after desmopressin (p=0.4203; p=0.6774). The density of GPIIb/IIIa receptors per platelet did not change after desmopressin (p=0.9652). The density of GPIb/IX receptors per platelet rose after desmopressin without reaching the level of significance (p=0.0802). In the desmopressin group alone the receptor density rose by 5.5% (p=0.0783). CONCLUSION: The administration of desmopressin improved the primary haemostasis when given in addition to a clopidogrel therapy. Patients undergoing a heart catheter procedure with clopidogrel might benefit from the use of desmopressin when having a bleeding episode.

Comparison between nasal and intravenous desmopressin for the treatment of aminosalicylic acid-induced platelet dysfunction.

BACKGROUND AND OBJECTIVE: The study was conducted to compare the standard intravenous route with the intranasal route of desmopressin application and to establish the best time for initiating treatment with desmopressin with the use of the Born test and the PFA 100-Analyzer for monitoring the therapeutic effect. METHODS: Thirty healthy volunteers (ASA I) with no known bleeding disorder were randomly assigned to an intravenous or an intranasal group in a cross-over design fashion. After obtaining baseline values, the volunteers were given 500 mg aminosalicylic acid for 3 days. On day 4, platelet function tests were performed and desmopressin (0.3 microg kg(-1) body weight) was administered either intravenously or intranasally. Born tests (aggregation after stimulation with epinephrine and collagen) were conducted at 30 and 240 min, and PFA 100 bleeding time measurements were conducted at 30, 120 and 240 min after desmopressin administration. Wilcoxon signed rank sum tests or non-parametric ANOVA for repeated measures were used for statistical evaluation. RESULTS: All volunteers showed a marked decreased platelet function in the Born test (especially if stimulation with epinephrine was used) and an increased PFA 100 bleeding time after treatment with aminosalicylic acid. Platelet function was improved by intravenous as well as intranasal application of desmopressin (P < 0.001) after 30 min. The effect diminished after 4 h in both groups. CONCLUSIONS: Intravenous as well as intranasal desmopressin improved platelet function in healthy volunteers with aminosalicylic acid-induced platelet dysfunction at least 30 min after application. The effect lasts up to 4 h.