title: Association Between Initial Emergency Department Lactate and Use of Vasoactive Medication in Children With Septic Shock.
abstract: OBJECTIVE
  Current guidelines emphasize early recognition of pediatric septic shock using clinical examination findings. Elevated serum lactate has been associated with increased mortality in adult patients with septic shock. Our objective was to determine the association between the initial serum lactate obtained in the pediatric emergency department (PED) from patients treated for septic shock and the use of vasoactive medication within 24 hours.
  
  
  METHODS
  This was a retrospective study from 2008 through 2012 of PED patients at a tertiary care children's hospital. Patients younger than 18 years treated for septic shock were included if they had a serum lactate obtained in the PED.
  
  
  RESULTS
  Eight hundred sixty-four PED encounters met inclusion criteria. Median initial PED lactate was 2.1 mmol/L (interquartile range, 1.4-3.2 mmol/L). Overall, 121 patients (14%) received vasoactive medication within 24 hours of the initial PED lactate. A multivariable logistic regression analysis demonstrated associations between initial lactate levels of 3.1 to 5 mmol/L (odds ratio, 1.82; 95% confidence interval, 1.02-3.26) and 5.1 mmol/L or greater (odds ratio, 5.00; 95% confidence interval, 2.56-9.76) and the use of vasoactive medication within 24 hours. Other factors associated with use of vasoactive medication within 24 hours included hypotension, abnormal pulses, and mental status changes.
  
  
  CONCLUSIONS
  Increased initial lactate is associated with use of vasoactive medication within 24 hours in PED patients with septic shock.
authors.affiliation: From the Division of Pediatric Emergency Medicine, Department of Pediatrics.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Miescier
authors.affiliation: From the Division of Pediatric Emergency Medicine, Department of Pediatrics.
authors.forename: Roni D
authors.initials: RD
authors.lastname: Lane
authors.affiliation: Department of Pediatrics, and.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Sheng
authors.affiliation: Division of Pediatric Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Gitte Y
authors.initials: GY
authors.lastname: Larsen
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019344:Lactic Acid / Q000097:blood*; D016015:Logistic Models; D010343:Patient Admission; D012016:Reference Values; D012189:Retrospective Studies; D012772:Shock, Septic / Q000097:blood* / Q000401:mortality / Q000628:therapy; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D055986:Vital Signs
chemical_list: D014662:Vasoconstrictor Agents; D019344:Lactic Acid