• Jorge A Ortega-Hernández, Héctor González-Pacheco, Mauricio García-Ruiz, Daniel Manzur-Sandoval, Rodrigo Gopar-Nieto, Daniel Sierra-Lara-Martínez, Diego Araiza-Garaygordobil, Salvador Mendoza-García, Arturo Arzate-Ramírez, Álvaro Montañez-Orozco, Luis Augusto Baeza-Herrera, Alfredo Altamirano-Castillo, Adrian Aquiles Valdespino Trejo, Jaime Hernández-Montfort, and Alexandra Arias-Mendoza.
• Instituto Nacional de Cardiología Ignacio Chávez, Coronary Care Unit, Juan Badiano 1, Sección XVI, Tlalpan 14080, Ciudad De México, Mexico. Electronic address: jorgeoh1992@gmail.com.
• J Crit Care. 2024 Dec 11; 86: 154990154990.

IntroductionLactate clearance(LC) is critical in managing critically ill patients. We hypothesized that treatment allocation with different vasoactive drugs or the presence of a pulmonary artery catheter (PAC) could affect the behavior of lactate dynamics and, ultimately, the mortality in AMI-CS.Materials And MethodsIn 651 patients with AMI-CS, we examined the relationship of LC time with clinical, laboratory, and CS-management variables. Complete LC time was defined as serum lactate levels less than <2 mmol/L. We explore the impact of vasoactive drugs and PAC with LC. The CART method defined the vasoactive combinations (permutations) in relation with early (<96 h) complete LC.ResultsPAC presence correlated with faster LC (-17.54 h) and was independently associated with lower mortality (HR = 0.61). Levosimendan and dobutamine were associated with lower lactate levels and faster LC (-8.82 & -8.77 h), while vasopressin was linked to slower LC (9.16 h). Slow LC (>96 h) was associated with increased mortality. CART analysis identified specific vasoactive drug combinations associated lactate clearance and mortality, without dobutamine, with vasopressin having higher mortality (80.6 %, HR = 5.53), and with dobutamine, with norepinephrine, without vasopressin, with levosimendan the lowest (35 %) and higher complete LC and a trend for higher %LC.ConclusionThe right combination of vasoactive medications and the probable use of a PAC could significantly impact the achievement of complete LC in <96 h. The findings support the need for further research and the development of strategies to optimize lactate clearance and improve overall patient survival in this high-risk population.Copyright © 2024 Elsevier Inc. All rights reserved.

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