Increased lactate levels are associated with poor prognosis and mortality in patients with sepsis [ 14 , 15 , 16 ], and it has been suggested that serum lactate could be included in risk stratification scores to increase their ability to detect sepsis and predict mortality in patients with infection [ 17 , 18 , 19 , 20 ]. Prehospital lactate analysis could potentially lead to earlier detection of severe sepsis. In an unselected cohort, elevated prehospital lactate was shown to predict mortality and discriminate patients at risk of death in the group categorized as low risk by NEWS2 [ 21 ]. In another unselected prehospital cohort however, lactate measurement did not help in predicting sepsis or time-sensitive conditions [ 22 , 23 ]. Among sepsis patients, a prehospital lactate > 4 mmol/l was shown to be a notable risk factor for mortality [ 24 ], suggesting prehospital lactate to be a possible tool to improve detection of patients with sepsis and increased mortality risk.
Gauguin approaches the life cycle from a feminine perspective. The girl surrounded by kittens demonstrates the purity of "girlhood". The figure in the center is placed in a "Garden of Eden motif"; she is picking fruits from a tree. Gauguin intended to represent this woman as a sin, like the allegory of Eve . Maternity is represented through the figures that surround the baby. Along with the motherhood of a woman's life, Gauguin also displays the idea of "domestic submission" through the bracelet and collar worn by the mature woman on the left and the white goat, respectively. Finally, the state of seniority can be seen through the old woman on the left. [ 1 ]
In this brief perspective, our aim is not to create and validate a new score, but rather to highlight potential challenges and areas for ongoing deliberation in the development of a SOFA score. We obtained an informal consensus among the authors, many of whom have decades of experience with the SOFA score and are thus aware of its strengths and weaknesses. Importantly, management of critically ill pediatric patients differs from that of adults, as do their physiological variables, so our discussions relate only to adult patients.
For the Swiss ICU-registry, daily SOFA scores are calculated by physicians (for the previous 24 h, 07:00 am–07:00 am) and include the total score as well as scores from each of the six organ-specific components. In all participating ICUs, the calculation of the SOFA score is performed according to the guidelines released by the Swiss Society of Intensive Care Medicine [ 14 ]. In the specific case of ICU stays < 24 h, the SOFA score is calculated based on data from ICU admission to discharge, incorporating data (., laboratory values) from 07:00 am on the day of ICU admission. If necessary, data will be extrapolated based on data recorded during ICU stay (. urine output). If a pathological laboratory value is not re-measured, the value can be carried forward for a maximum of 72 h. A value of 0 is assigned if the SOFA component is within the normal range, never determined, or not re-determined after 72 h. Facing the well-established challenge of Glasgow Coma Scale (GSC) calculation in sedated and intubated patients in the ICU, the assumed (if the patient did not receive sedation) or last known GCS is used.
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