1. © 2009 OPTI Medical Systems, Inc. All rights reserved. OPTI CCA-TS-lactate OPTI CCA-TS-lactate

2. © 2009 OPTI Medical Systems, Inc. All rights reserved. Produced by cells during anaerobic glycolysis. Normal Range: 0.5 to 2.2 mmol/L. High lactate levels: >4mmol/L May rise in severe exercise to 20 mmol/L What is lactate? Lactate

3. © 2009 OPTI Medical Systems, Inc. All rights reserved. Processed by the liver and kidneys. Lactic acidosis is when H+ ions build up leading to a drop in pH. The following symptoms appear with lactate levels above 4 mmol/L: increased heart rate increased respiratory rate alteration in mental status. What is lactic acidosis? Lactate

4. © 2009 OPTI Medical Systems, Inc. All rights reserved. Lactic acidosis is separated into two types: A and B. Types of lactic acidosis Type A CausesType B Causes Shock from blood lossSevere infections – sepsis and meningitis Heart attackKidney disease Congestive heart failure Liver disease Pulmonary edemaDiabetes Severe anemiaLeukemia Carbon monoxideAIDS Drugs and toxins (metformin, salicylate, etc) Metabolic and mitochondrial diseases Strenuous exercise Type A lactic acidosis is associated with hypoperfusion or hypoxia. It is usually a feature of acute critical illness. Type B lactic acidosis is caused by conditions that increase the amount of lactate/lactic acid in the blood. Occurs with adequate tissue oxygenation and normal hemodynamics (blood pressure, volume, etc.)

5. © 2009 OPTI Medical Systems, Inc. All rights reserved. Where is lactate tested? Lactate

6. © 2009 OPTI Medical Systems, Inc. All rights reserved. Where is lactate tested? Lactate

7. © 2009 OPTI Medical Systems, Inc. All rights reserved. Lactate is a precursor to sepsis- life threatening blood infection Lactate is good prognosticator of morbidity (death rate) and mortality (death). The greater the increase in lactate, the greater the mortality. What is the clinical significance of lactate? Lactate

8. © 2009 OPTI Medical Systems, Inc. All rights reserved. In a study of 1278 patients with infection, mortality was 4.9% among those whose lactate was less than 2.5 mmol/L on admission compared with 28.4% among those whose lactate was >4mmol/L. What is the clinical significance of lactate?

9. © 2009 OPTI Medical Systems, Inc. All rights reserved. Greater accuracy of results Arterial lactate levels represent total body lactate levels. Lactate with arterial blood gases are relevant for patients presenting with: hypoxia shock suspected sepsis mechanical ventilation Why test lactate with ABGs? Lactate with ABG

10. © 2009 OPTI Medical Systems, Inc. All rights reserved. SepsisSepsis and Lactate Sepsis

11. © 2009 OPTI Medical Systems, Inc. All rights reserved. More than 750,000 individuals develop severe sepsis in North America each year, with similar estimates for Europe. The death rate for severe sepsis is 30-35% and the death rate for septic shock is around 50%. The goal of the Surviving Sepsis Campaign is to reduce the mortality rate of sepsis by 25%. Lactate and the Surviving Sepsis Campaign Sepsis

12. © 2009 OPTI Medical Systems, Inc. All rights reserved. Fast accurate lactate results is critical for surviving sepsis guidelines. Protocols recommend ABG plus lactate results within 10 minutes. Current lab turn around times are > 30 minutes. Lactate and the Surviving Sepsis Campaign Sepsis

13. © 2009 OPTI Medical Systems, Inc. All rights reserved. Features and Benefits of the B-Lac cassette FeatureBenefit Fast turn around time at the point of care Increases efficiency Improves patient outcomes Fast turn around time- 3-5 mins opposed to 30 mins by lab Blood gas results with lactateClinically relevant for critical care medicine. Test on whole bloodNo sample preparation. B-Lac cassette

14. © 2009 OPTI Medical Systems, Inc. All rights reserved. Lactate Cassette Specifications Measures: pH, PO 2, PCO 2, tHb, SO 2, and lactate Lactate range: 0.3 - 17.5 mmol/L (all others parameters are the same) Specimen: Whole blood only Storage: 2°C - 8°C Shelf life: 12 months Handling: Cassettes must be brought to room temperature for 1 hour prior to use. Usage: OPTI CCA-TS only. All serial numbers. Requires v3.0 software Controls: Uses OPTI Check controls Overview