ブックタイトル第43回日本集中治療医学会学術集会プログラム・抄録集

概要

第43回日本集中治療医学会学術集会プログラム・抄録集

－178－SL1Department of Intensive Care, CHIREC Hospitals, Universite Libre de Bruxelles, Brussels, BelgiumDaniel De BackerMeasurements of blood lactate levels may be useful to detect occult tissue hypoxia and also to monitor the effects of therapy.Lactate is a byproduct of glycolysis. In the first phase which occurs in the cytoplasm of the cell and does not require oxygen,glucose is transformed into pyruvate. Pyruvate can be transformed into lactate or enter the mitochondria to participate in thesecond phase of reactions, generating ATP, H2O and CO2. This second phase does require the presence of oxygen. In normalconditions, most pyruvate will enter the mitochondria, so that the normal lactate/pyruvate ratio is around 10. In anaerobicconditions, pyruvate cannot enter the mitochondria and massive amounts of lactate will be produced.It is commonly accepted that hyperlactatemia is mostly of hypoxic origin in critically ill patients with circulatory failure.However, tissue hypoxia cannot be sustained for long periods of time without inducing cell death, as the energy produced byanaerobic metabolism is quite low compared to aerobic metabolism. Mild hyperlactatemia in hemodynamically stable septicpatients is often not related to tissue hypoxia.Sepsis-induced inflammatory mediators accelerate aerobic glycolysis, increasing pyruvate availability. The increase pyruvateavailability can lead to increased lactate production, even in presence of large amounts of oxygen. In addition to the increasedlactate production, a decrease in lactate clearance can participate in hyperlactatemia.Recent studies also indicate that lactate can be used as fuel by different tissues, including the brain. Accordingly therapy shouldnot aim at suppressing lactate but rather suppressing the cause of hyperlactatemia. In some situations, exogenous administrationof lactate can even be considered.特別講演 1 2月12日（金）　15：40～16：30　第5会場Lactate RevisitedSL2Department of Pulmonary and Critical Care and Health Services Research, Vanderbilt University, USAE. Wesley ElyIt is imperative societally and as healthcare professional that we increasingly focus on the public health problem of acute andlong-term brain dysfunction amongst critically ill patients during and following their illness. Delirium is an extremely commonorgan dysfunction and a strong independent predictor of length of stay, cost of care, death, and long-term cognitive impairmentthat resembles an acquired dementia of the severity of Alzheimer's disease or traumatic brain injury. Numerous modifiablecauses have been identified（including delirium duration）and workers all over the world are attempting to reduce the onsetand duration of delirium and both prevent and manage the long-term acquired dementia?like illness that ICU survivors sufferfrom so severely. It is high time that medical interventions designed to improve neurological recovery are subjected toappropriately designed and robustly powered randomized controlled trials. Now ICU’s are working diligently to implement theSCCM’s PAD guidelines using the evidence-based ABCDEF Bundle as part of the ICU Liberation Collaborative. Moreinformation is available at www.icudelirium.org and www.iculiberation.org.特別講演 2 2月12日（金）　14：40～15：30　第6会場Prevention of delirium