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Lactate monitoring in the ICU 

Lactate monitoring in the ICU
Chapter:
Lactate monitoring in the ICU
Author(s):

Tim C. Jansen

and Jan Bakker

DOI:
10.1093/med/9780199600830.003.0139
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date: 01 December 2020

An increased blood lactate level (hyperlactataemia) is commonplace in critically-ill patients. Lactate is usually measured with the aim of detecting tissue hypoxia, but this is an oversimplification as aerobic processes can also result in increased levels. Understanding of the various anaerobic and aerobic mechanisms of production and clearance is essential for the correct interpretation of hyperlactataemia. Despite the broad differential diagnosis, hyperlactataemia generally predicts adverse outcomes. The consistency of its prognostic value emphasizes its place in the risk stratification of critically-ill patients. Lactate clearance was non-inferior to central venous oxygen saturation as a goal of early resuscitation in patients presenting to the emergency department with severe sepsis or septic shock. Therapy guidance by lactate monitoring significantly reduced hospital mortality in ICU patients admitted with hyperlactataemia after adjustment for predefined risk factors, a finding consistent with important secondary endpoints. These results confirm that lactate monitoring offers clinical benefit and should be incorporated within a goal-directed therapy strategy.

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