Hyperlactatemia is a strong predictor of mortality in diverse populations of critically ill patients. In this article, we will give an overview of how lactate is used in the intensive care unit. We describe the use of lactate as a predictor of outcome, as a marker to initiate therapy and to monitor adequacy of initiated treatments.
KompanjeEJJansenTCvan derHBBakkerJ. The first demonstration of lactic acid in human blood in shock by Johann Joseph Scherer (1814-1869) in January 1843. Intensive Care Med. 2007;33(11):1967–1971.
2.
BroderGWeilMH. Excess lactate: an index of reversibility of shock in human patients. Science. 1964;143(3613):1457–1459.
3.
JansenTCvan BommelJSchoonderbeekFJ. Early lactate-guided therapy in intensive care unit patients: a multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med. 2010;182(6):752–761.
4.
KrautJAMadiasNE. Lactic acidosis. N Engl J Med. 2014;371(24):2309–2319.
5.
BakkerJNijstenMWJansenTC. Clinical use of lactate monitoring in critically ill patients. Ann Intensive Care. 2013;3(1):12.
6.
KreisbergRA. Glucose-lactate inter-relations in man. N Engl J Med. 1972;287(3):132–137.
7.
FallPJSzerlipHM. Lactic acidosis: from sour milk to septic shock. J Intensive Care Med. 2005;20(5):255–271.
8.
JansenTCvan BommelJBakkerJ. Blood lactate monitoring in critically ill patients: a systematic health technology assessment. Crit Care Med. 2009;37(10):2827–2839.
9.
FriedmanGde BackerDShahlaMVincentJL. Oxygen supply dependency can characterize septic shock. Intensive Care Med. 1998;24(2):118–123.
10.
InceC. The microcirculation is the motor of sepsis. Crit Care. 2005;9(suppl 4):S13–S19.
11.
EllisCGBatemanRMSharpeMDSibbaldWJGillR. Effect of a maldistribution of microvascular blood flow on capillary O(2) extraction in sepsis. Am J Physiol Heart Circ Physiol. 2002;282(1):H156–H164.
12.
GoldmanDBatemanRMEllisCG. Effect of sepsis on skeletal muscle oxygen consumption and tissue oxygenation: interpreting capillary oxygen transport data using a mathematical model. Am J Physiol Heart Circ Physiol. 2004;287(6):H2535–H2544.
13.
ClausenTFlatmanJA. Beta 2-adrenoceptors mediate the stimulating effect of adrenaline on active electrogenic Na-K-transport in rat soleus muscle. Br J Pharmacol. 1980;68(4):749–755.
14.
DietzMRChiassonJLSoderlingTRExtonJH. Epinephrine regulation of skeletal muscle glycogen metabolism. Studies utilizing the perfused rat hindlimb preparation. J Biol Chem. 1980;255(6):2301–2307.
15.
LevrautJCiebieraJPChaveS. Mild hyperlactatemia in stable septic patients is due to impaired lactate clearance rather than overproduction. Am J Respir Crit Care Med. 1998;157(4 pt 1):1021–1026.
16.
RevellyJPTappyLMartinezA. Lactate and glucose metabolism in severe sepsis and cardiogenic shock. Crit Care Med. 2005;33(10):2235–2240.
17.
TapiaPSotoDBruhnA. Impairment of exogenous lactate clearance in experimental hyperdynamic septic shock is not related to total liver hypoperfusion. Crit Care. 2015;19:188.
18.
VincentJL. Serial blood lactate levels reflect both lactate production and clearance. Crit Care Med. 2015;43(6):e209.
19.
HowellMDDonninoMClardyPTalmorDShapiroNI. Occult hypoperfusion and mortality in patients with suspected infection. Intensive Care Med. 2007;33(11):1892–1899.
20.
TrzeciakSDellingerRPChanskyME. Serum lactate as a predictor of mortality in patients with infection. Intensive Care Med. 2007;33(6):970–977.
21.
MikkelsenMEMiltiadesANGaieskiDF. Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock. Crit Care Med. 2009;37(5):1670–1677.
22.
ShapiroNIHowellMDTalmorD. Serum lactate as a predictor of mortality in emergency department patients with infection. Ann Emerg Med. 2005;45(5):524–528.
23.
PuskarichMATrzeciakSShapiroNI. Whole blood lactate kinetics in patients undergoing quantitative resuscitation for severe sepsis and septic shock. Chest. 2013;143(6):1548–1553.
24.
SmithIKumarPMolloyS. Base excess and lactate as prognostic indicators for patients admitted to intensive care. Intensive Care Med. 2001;27(1):74–83.
25.
JansenTCvanBJWoodwardRMulderPGBakkerJ. Association between blood lactate levels, Sequential Organ Failure Assessment subscores, and 28-day mortality during early and late intensive care unit stay: a retrospective observational study. Crit Care Med. 2009;37(8):2369–2374.
26.
JansenTCvanBJMulderPGRommesJHSchieveldSJBakkerJ. The prognostic value of blood lactate levels relative to that of vital signs in the pre-hospital setting: a pilot study. Crit Care. 2008;12(6):R160.
27.
VanniSVivianiGBaioniM. Prognostic value of plasma lactate levels among patients with acute pulmonary embolism: the thrombo-embolism lactate outcome study. Ann Emerg Med. 2013;61(3):330–338.
28.
MeregalliAOliveiraRPFriedmanG. Occult hypoperfusion is associated with increased mortality in hemodynamically stable, high-risk, surgical patients. Crit Care. 2004;8(2):R60–R65.
29.
GuyetteFSuffolettoBCastilloJLQuinteroJCallawayCPuyanaJC. Prehospital serum lactate as a predictor of outcomes in trauma patients: a retrospective observational study. J Trauma. 2011;70(4):782–786.
30.
PalJDVictorinoGPTwomeyPLiuTHBullardMKHarkenAH. Admission serum lactate levels do not predict mortality in the acutely injured patient. J Trauma. 2006;60(3):583–587.
31.
CallawayDWShapiroNIDonninoMWBakerCRosenCL. Serum lactate and base deficit as predictors of mortality in normotensive elderly blunt trauma patients. J Trauma. 2009;66(4):1040–1044.
32.
KaplanLJKellumJA. Initial pH, base deficit, lactate, anion gap, strong ion difference, and strong ion gap predict outcome from major vascular injury. Crit Care Med. 2004;32(5):1120–1124.
33.
JansenTCvan BommelJMulderPG. Prognostic value of blood lactate levels: does the clinical diagnosis at admission matter?J Trauma. 2009;66(2):377–385.
34.
BakkerJGrisPCoffernilsMKahnRJVincentJL. Serial blood lactate levels can predict the development of multiple organ failure following septic shock. Am J Surg. 1996;171(2):221–226.
35.
ClaridgeJACrabtreeTDPelletierSJButlerKSawyerRGYoungJS. Persistent occult hypoperfusion is associated with a significant increase in infection rate and mortality in major trauma patients. J Trauma. 2000;48(1):8–14.
36.
SuistomaaMRuokonenEKariATakalaJ. Time-pattern of lactate and lactate to pyruvate ratio in the first 24 hours of intensive care emergency admissions. Shock. 2000;14(1):8–12.
37.
MarikPEBankovA. Sublingual capnometry versus traditional markers of tissue oxygenation in critically ill patients. Crit Care Med. 2003;31(3):818–822.
38.
WatanabeIMayumiTArishimaT. Hyperlactemia can predict the prognosis of liver resection. Shock. 2007;28(1):35–38.
39.
DonninoMWMillerJGoyalN. Effective lactate clearance is associated with improved outcome in post-cardiac arrest patients. Resuscitation. 2007;75(2):229–234.
40.
KliegelALosertHSterzF. Serial lactate determinations for prediction of outcome after cardiac arrest. Medicine (Baltimore). 2004;83(5):274–279.
41.
ArnoldRCShapiroNIJonesAE. Multicenter study of early lactate clearance as a determinant of survival in patients with presumed sepsis. Shock. 2009;32(1):35–39.
42.
NguyenHBRiversEPKnoblichBP. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med. 2004;32(8):1637–1642.
43.
VincentJLSilvaQECoutoLJrTacconeFS. The value of blood lactate kinetics in critically ill patients: a systematic review. Crit Care. 2016;20(1):257.
44.
CasserlyBPhillipsGSSchorrC. Lactate measurements in sepsis-induced tissue hypoperfusion: results from the Surviving Sepsis Campaign database. Crit Care Med. 2015;43(3):567–573.
45.
ZhangZXuX. Lactate clearance is a useful biomarker for the prediction of all-cause mortality in critically ill patients: a systematic review and meta-analysis. Crit Care Med. 2014;42(9):2118–2125.
46.
BakkerJ. Lost in translation: on lactate, hypotension, sepsis-induced tissue hypoperfusion, quantitative resuscitation and Surviving Sepsis Campaign bundles. Crit Care Med. 2015;43(3):705–706.
47.
BakkerJJansenTC. Don’t take vitals, take a lactate. Intensive Care Med. 2007;33(11):1863–1865.
48.
CecconiMDeBDAntonelliM. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014;40(12):1795–1815.
49.
DellingerRPLevyMMRhodesA. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39(2):165–228.
50.
EastridgeBJSalinasJMcManusJG. Hypotension begins at 110 mm Hg: redefining “hypotension” with data. J Trauma. 2007;63(2):291–297.
51.
AnderDSJaggiMRiversE. Undetected cardiogenic shock in patients with congestive heart failure presenting to the emergency department. Am J Cardiol. 1998;82(7):888–891.
52.
RadyMYRiversEPNowakRM. Resuscitation of the critically ill in the ED: responses of blood pressure, heart rate, shock index, central venous oxygen saturation, and lactate. Am J Emerg Med. 1996;14(2):218–225.
53.
VandrommeMJGriffinRLWeinbergJARueLWIIIKerbyJD. Lactate is a better predictor than systolic blood pressure for determining blood requirement and mortality: could prehospital measures improve trauma triage?J Am Coll Surg. 2010;210(5):861–869.
54.
van BeestPAMulderPJOetomoSBvan denBBKuiperMASpronkPE. Measurement of lactate in a prehospital setting is related to outcome. Eur J Emerg Med. 2009;16(6):318–322.
55.
PolonenPRuokonenEHippelainenMPoyhonenMTakalaJ. A prospective, randomized study of goal-oriented hemodynamic therapy in cardiac surgical patients. Anesth Analg. 2000;90(5):1052–1059.
56.
RiversENguyenBHavstadS. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368–1377.
57.
SeversDHoornEJRookmaakerMB. A critical appraisal of intravenous fluids: from the physiological basis to clinical evidence. Nephrol Dial Transplant. 2015;30(2):178–187.
58.
DayNPPhuNHBethellDP. The effects of dopamine and adrenaline infusions on acid-base balance and systemic haemodynamics in severe infection. Lancet. 1996;348(9022):219–223.
59.
LevyBMansartABollaertPEFranckPMallieJP. Effects of epinephrine and norepinephrine on hemodynamics, oxidative metabolism, and organ energetics in endotoxemic rats. Intensive Care Med. 2003;29(2):292–300.
60.
HernandezGPenaHCornejoR. Impact of emergency intubation on central venous oxygen saturation in critically ill patients: a multicenter observational study. Crit Care. 2009;13(3):R63.
61.
AubierMViiresNSyllieGMozesRRoussosC. Respiratory muscle contribution to lactic acidosis in low cardiac output. Am Rev Respir Dis. 1982;126(4):648–652.
62.
GuWJZhangZBakkerJ. Early lactate clearance-guided therapy in patients with sepsis: a meta-analysis with trial sequential analysis of randomized controlled trials. Intensive Care Med. 2015;41(10):1862–1863.
63.
HernandezGLuengoCBruhnA. When to stop septic shock resuscitation: clues from a dynamic perfusion monitoring. Ann Intensive Care. 2014;430.
64.
JonesAEShapiroNITrzeciakSArnoldRCClaremontHAKlineJA. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA. 2010;303(8):739–746.
65.
PuskarichMATrzeciakSShapiroNI. Prognostic value and agreement of achieving lactate clearance or central venous oxygen saturation goals during early sepsis resuscitation. Acad Emerg Med. 2012;19(3):252–258.
66.
NicholADEgiMPettilaV. Relative hyperlactatemia and hospital mortality in critically ill patients: a retrospective multi-centre study. Crit Care. 2010;14(1):R25.
