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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2013

Open Access 01-12-2013 | Review

Clinical use of lactate monitoring in critically ill patients

Authors: Jan Bakker, Maarten WN Nijsten, Tim C Jansen

Published in: Annals of Intensive Care | Issue 1/2013

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Abstract

Increased blood lactate levels (hyperlactataemia) are common in critically ill patients. Although frequently used to diagnose inadequate tissue oxygenation, other processes not related to tissue oxygenation may increase lactate levels. Especially in critically ill patients, increased glycolysis may be an important cause of hyperlactataemia. Nevertheless, the presence of increased lactate levels has important implications for the morbidity and mortality of the hyperlactataemic patients. Although the term lactic acidosis is frequently used, a significant relationship between lactate and pH only exists at higher lactate levels. The term lactate associated acidosis is therefore more appropriate. Two recent studies have underscored the importance of monitoring lactate levels and adjust treatment to the change in lactate levels in early resuscitation. As lactate levels can be measured rapidly at the bedside from various sources, structured lactate measurements should be incorporated in resuscitation protocols.
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Literature
1.
Kompanje EJ, Jansen TC, van der Hoven B, Bakker J: 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. 10.1007/s00134-007-0788-7PubMedCentralCrossRefPubMed
2.
Araki T: Ueber die Bildung von Milchsäure und Glycose im Organismus bei Sauerstoffmangel. Z Physiol Chem 1891, 15: 335–370.
3.
Leverve XM: Energy metabolism in critically ill patients: lactate is a major oxidizable substrate. Curr Opin Clin Nutr Metab Care 1999,2(2):165–169. 10.1097/00075197-199903000-00013CrossRefPubMed
4.
5.
6.
Stewart PA: Modern quantitative acid–base chemistry. Can J Physiol Pharmacol 1983,61(12):1444–1461. 10.1139/y83-207CrossRefPubMed
7.
Gunnerson KJ, Saul M, He S, Kellum JA: Lactate versus non-lactate metabolic acidosis: a retrospective outcome evaluation of critically ill patients. Crit Care 2006,10(1):R22. 10.1186/cc3987PubMedCentralCrossRefPubMed
8.
Fall PJ, Szerlip HM: Lactic acidosis: from sour milk to septic shock. J Intensive Care Med 2005,20(5):255–271. 10.1177/0885066605278644CrossRefPubMed
9.
Cain SM: Appearance of excess lactate in anesthetized dogs during anemic and hypoxic hypoxia. Am J Physiol 1965, 209: 604–608.PubMed
10.
Zhang H, Vincent JL: Oxygen extraction is altered by endotoxin during tamponade-induced stagnant hypoxia in the dog. Circ Shock J1 - CS 1993,40(3):168–176.
11.
Bakker J, Vincent J-L: The oxygen supply dependency phenomenon is associated with increased blood lactate levels. J Crit Care 1991, 6: 152–159. 10.1016/0883-9441(91)90006-FCrossRef
12.
Ronco JJ, Fenwick JC, Tweeddale MG, Wiggs BR, Phang PT, Cooper DJ, Cunningham KF, Russell JA, Walley KR: Identification of the critical oxygen delivery for anaerobic metabolism in critically ill septic and nonseptic humans. JAMA 1993,270(14):1724–1730. 10.1001/jama.1993.03510140084034CrossRefPubMed
13.
Friedman G, De Backer D, Shahla M, Vincent JL: Oxygen supply dependency can characterize septic shock. Intensive Care Med 1998,24(2):118–123. 10.1007/s001340050531CrossRefPubMed
14.
De Backer D, Creteur J, Dubois MJ, Sakr Y, Koch M, Verdant C, Vincent JL: The effects of dobutamine on microcirculatory alterations in patients with septic shock are independent of its systemic effects. Crit Care Med 2006,34(2):403–408. 10.1097/01.CCM.0000198107.61493.5ACrossRefPubMed
15.
Leverve XM: From tissue perfusion to metabolic marker: assessing organ competition and co-operation in critically ill patients? Intensive Care Med 1999,25(9):890–892. 10.1007/s001340050976CrossRefPubMed
16.
Levy B, Sadoune LO, Gelot AM, Bollaert PE, Nabet P, Larcan A: Evolution of lactate/pyruvate and arterial ketone body ratios in the early course of catecholamine-treated septic shock [see comments]. Crit Care Med 2000,28(1):114–119. 10.1097/00003246-200001000-00019CrossRefPubMed
17.
Levy B, Bollaert PE, Charpentier C, Nace L, Audibert G, Bauer P, Nabet P, Larcan A: Comparison of norepinephrine and dobutamine to epinephrine for hemodynamics, lactate metabolism, and gastric tonometric variables in septic shock: a prospective, randomized study. Intensive Care Med 1997,23(3):282–287. 10.1007/s001340050329CrossRefPubMed
18.
Weil MH, Tang W: Forty-five-year evolution of stat blood and plasma lactate measurement to guide critical care. Clin Chem 2009,55(11):2053–2054. 10.1373/clinchem.2009.133553CrossRefPubMed
19.
Griffith FR Jr, Lockwood JE, Emery FE: Adrenalin lactacidemia: proportionality with dose. Am J Physiol 1939,127(3):415–421.
20.
Zborowska-Sluis DT, Dossetor JB: Hyperlactatemia of hyperventilation. J Appl Physiol J1 - JAP 1967,22(4):746–755.
21.
McMahon M, Gerich J, Rizza R: Effects of glucocorticoids on carbohydrate metabolism. Diabetes Metab Rev 1988,4(1):17–30. 10.1002/dmr.5610040105CrossRefPubMed
22.
Warburg O: On respiratory impairment in cancer cells. Science 1956,124(3215):269–270.PubMed
23.
Levy B, Gibot S, Franck P, Cravoisy A, Bollaert PE: Relation between muscle Na+K+ ATPase activity and raised lactate concentrations in septic shock: a prospective study. Lancet 2005,365(9462):871–875. 10.1016/S0140-6736(05)71045-XCrossRefPubMed
24.
Levy B, Desebbe O, Montemont C, Gibot S: Increased aerobic glycolysis through beta-2 stimulation is a common mechanism involved in lactate formation during shock states. Shock 2008,30(4):417–421. 10.1097/SHK.0b013e318167378fCrossRefPubMed
25.
Taylor DJ, Faragher EB, Evanson JM: Inflammatory cytokines stimulate glucose uptake and glycolysis but reduce glucose oxidation in human dermal fibroblasts in vitro. Circ Shock 1992,37(2):105–110.PubMed
26.
McCarter FD, Evans JA, Luchette FA, Friend LA, James JH, Davis K, Frame SB: Concurrent reduction of glycogenolysis, glycolysis, and Na(+)/K(+) pump activity after hemorrhagic shock. Curr Surg 2000,57(6):639.CrossRefPubMed
27.
Luchette FA, Friend LA, Brown CC, Upputuri RK, James JH: Increased skeletal muscle Na+, K+-ATPase activity as a cause of increased lactate production after hemorrhagic shock. J Trauma 1998,44(5):796–801. discussion 801–793 10.1097/00005373-199805000-00010CrossRefPubMed
28.
Haji-Michael PG, Ladriere L, Sener A, Vincent JL, Malaisse WJ: Leukocyte glycolysis and lactate output in animal sepsis and ex vivo human blood. Metabolism 1999,48(6):779–785. 10.1016/S0026-0495(99)90179-8CrossRefPubMed
29.
Brealey D, Brand M, Hargreaves I, Heales S, Land J, Smolenski R, Davies NA, Cooper CE, Singer M: Association between mitochondrial dysfunction and severity and outcome of septic shock. Lancet 2002,360(9328):219–223. 10.1016/S0140-6736(02)09459-XCrossRefPubMed
30.
Crouser ED, Julian MW, Blaho DV, Pfeiffer DR: Endotoxin-induced mitochondrial damage correlates with impaired respiratory activity. Crit Care Med 2002,30(2):276–284. 10.1097/00003246-200202000-00002CrossRefPubMed
31.
Didwania A, Miller J, Kassel D, Jackson EVJ, Chernow B: Effect of intravenous lactated Ringer’s solution infusion on the circulating lactate concentration: Part 3. Results of a prospective, randomized, double-blind, placebo-controlled trial. Crit Care Med 1997,25(11):1851–1854. 10.1097/00003246-199711000-00024CrossRefPubMed
32.
Levraut J, Ciebiera JP, Jambou P, Ichai C, Labib Y, Grimaud D: Effect of continuous venovenous hemofiltration with dialysis on lactate clearance in critically ill patients. Crit Care Med 1997,25(1):58–62. 10.1097/00003246-199701000-00013CrossRefPubMed
33.
Cole L, Bellomo R, Baldwin I, Hayhoe M, Ronco C: The impact of lactate-buffered high-volume hemofiltration on acid–base balance. Intensive Care Med 2003,29(7):1113–1120. 10.1007/s00134-003-1812-1CrossRefPubMed
34.
Bollmann MD, Revelly JP, Tappy L, Berger MM, Schaller MD, Cayeux MC, Martinez A, Chiolero RL: Effect of bicarbonate and lactate buffer on glucose and lactate metabolism during hemodiafiltration in patients with multiple organ failure. Intensive Care Med 2004,30(6):1103–1110. 10.1007/s00134-004-2251-3CrossRefPubMed
35.
Lalau JD, Lacroix C, Compagnon P, de Cagny B, Rigaud JP, Bleichner G, Chauveau P, Dulbecco P, Guerin C, Haegy JM: Role of metformin accumulation in metformin-associated lactic acidosis. Diabetes Care 1995,18(6):779–784. 10.2337/diacare.18.6.779CrossRefPubMed
36.
Marinella MA: Lactic acidosis associated with propofol. Chest 1996,109(1):292. 10.1378/chest.109.1.292CrossRefPubMed
37.
Lonergan JT, Behling C, Pfander H, Hassanein TI, Mathews WC: Hyperlactatemia and hepatic abnormalities in 10 human immunodeficiency virus-infected patients receiving nucleoside analogue combination regimens. Clin Infect Dis 2000,31(1):162–166. 10.1086/313912CrossRefPubMed
38.
Claessens YE, Cariou A, Monchi M, Soufir L, Azoulay E, Rouges P, Goldgran-Toledano D, Branche F, Dhainaut JF: Detecting life-threatening lactic acidosis related to nucleoside-analog treatment of human immunodeficiency virus-infected patients, and treatment with L-carnitine. Crit Care Med 2003,31(4):1042–1047. 10.1097/01.CCM.0000053649.69377.08CrossRefPubMed
39.
Naidoo DP, Gathiram V, Sadhabiriss A, Hassen F: Clinical diagnosis of cardiac beriberi. S Afr Med J 1990,77(3):125–127.PubMed
40.
Morgan TJ, Clark C, Clague A: Artifactual elevation of measured plasma L-lactate concentration in the presence of glycolate. Crit Care Med 1999,27(10):2177–2179. 10.1097/00003246-199910000-00017CrossRefPubMed
41.
Brindley PG, Butler MS, Cembrowski G, Brindley DN: Falsely elevated point-of-care lactate measurement after ingestion of ethylene glycol. CMAJ 2007,176(8):1097–1099.PubMedCentralCrossRefPubMed
42.
Leverve XM, Boon C, Hakim T, Anwar M, Siregar E, Mustafa I: Half-molar sodium-lactate solution has a beneficial effect in patients after coronary artery bypass grafting. Intensive Care Med 2008,34(10):1796–1803. 10.1007/s00134-008-1165-xCrossRefPubMed
43.
Almenoff PL, Leavy J, Weil MH, Goldberg NB, Vega D, Rackow EC: Prolongation of the half-life of lactate after maximal exercise in patients with hepatic dysfunction. Crit Care Med 1989,17(9):870–873. 10.1097/00003246-198909000-00004CrossRefPubMed
44.
Mustafa I, Roth H, Hanafiah A, Hakim T, Anwar M, Siregar E, Leverve XM: Effect of cardiopulmonary bypass on lactate metabolism. Intensive Care Med 2003,29(8):1279–1285. 10.1007/s00134-003-1860-6CrossRefPubMed
45.
Vary TC: Sepsis-induced alterations in pyruvate dehydrogenase complex activity in rat skeletal muscle: effects on plasma lactate. Shock 1996,6(2):89–94. 10.1097/00024382-199608000-00002CrossRefPubMed
46.
Stacpoole PW, Wright EC, Baumgartner TG, Bersin RM, Buchalter S, Curry SH, Duncan CA, Harman EM, Henderson GN, Jenkinson S: A controlled clinical trial of dichloroacetate for treatment of lactic acidosis in adults. The Dichloroacetate-Lactic Acidosis Study Group. N Engl J Med 1992,327(22):1564–1569. 10.1056/NEJM199211263272204CrossRefPubMed
47.
Aduen J, Bernstein WK, Khastgir T, Miller J, Kerzner R, Bhatiani A, Lustgarten J, Bassin AS, Davison L, Chernow B: The use and clinical importance of a substrate-specific electrode for rapid determination of blood lactate concentrations. JAMA 1994,272(21):1678–1685. 10.1001/jama.1994.03520210062033CrossRefPubMed
48.
Brinkert W, Rommes JH, Bakker J: Lactate measurements in critically ill patients with a hand-held analyser. Intensive Care Med 1999,25(9):966–969. 10.1007/s001340050990CrossRefPubMed
49.
Weil MH, Michaels S, Rackow EC: Comparison of blood lactate concentrations in central venous, pulmonary artery, and arterial blood. Crit Care Med 1987,15(5):489–490.CrossRefPubMed
50.
Younger JG, Falk JL, Rothrock SG: Relationship between arterial and peripheral venous lactate levels. Acad Emerg Med 1996,3(7):730–734. 10.1111/j.1553-2712.1996.tb03502.xCrossRefPubMed
51.
Fauchere JC, Bauschatz AS, Arlettaz R, Zimmermann-Bar U, Bucher HU: Agreement between capillary and arterial lactate in the newborn. Acta Paediatr 2002,91(1):78–81. 10.1111/j.1651-2227.2002.tb01645.xCrossRefPubMed
52.
Noordally O, Vincent JL: Evaluation of a new, rapid lactate analyzer in critical care. Intensive Care Med 1999,25(5):508–513. 10.1007/s001340050889CrossRefPubMed
53.
Astles R, Williams CP, Sedor F: Stability of plasma lactate in vitro in the presence of antiglycolytic agents. Clin Chem 1994,40(7 Pt 1):1327–1330.PubMed
54.
Andersen O, Haugaard SB, Jorgensen LT, Sorensen S, Nielsen JO, Madsbad S, Iversen J: Preanalytical handling of samples for measurement of plasma lactate in HIV patients. Scand J Clin Lab Invest 2003,63(6):449–454. 10.1080/00365510310005128CrossRefPubMed
55.
Jansen TC, van Bommel J, Bakker J: Blood lactate monitoring in critically ill patients: a systematic health technology assessment. Crit Care Med 2009,37(10):2827–2839. 10.1097/CCM.0b013e3181a98899CrossRefPubMed
56.
Bakker J, Gris P, Coffernils M, Kahn RJ, Vincent JL: Serial blood lactate levels can predict the development of multiple organ failure following septic shock. Am J Surg 1996,171(2):221–226. 10.1016/S0002-9610(97)89552-9CrossRefPubMed
57.
Jansen TC, van Bommel J, Woodward R, Mulder PG, Bakker J: 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. 10.1097/CCM.0b013e3181a0f919CrossRefPubMed
58.
Jansen TC, van Bommel J, Mulder PG, Rommes JH, Schieveld SJ, Bakker J: 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. 10.1186/cc7159PubMedCentralCrossRefPubMed
59.
Bakker J, Coffernils M, Leon M, Gris P, Vincent J-L: Blood lactate levels are superior to oxygen-derived variables in predicting outcome in human septic shock. Chest 1991,99(4):956–962. 10.1378/chest.99.4.956CrossRefPubMed
60.
Howell M, Donnino M, Clardy P, Talmor D, Shapiro N: Occult hypoperfusion and mortality in patients with suspected infection. Intensive Care Med 2007,33(11):1892–1899. 10.1007/s00134-007-0680-5CrossRefPubMed
61.
Shapiro NI, Howell MD, Talmor D, Nathanson LA, Lisbon A, Wolfe RE, Weiss JW: Serum lactate as a predictor of mortality in emergency department patients with infection. Ann Emerg Med 2005,45(5):524–528. 10.1016/j.annemergmed.2004.12.006CrossRefPubMed
62.
Hernandez G, Bruhn A, Castro R, Regueira T: The holistic view on perfusion monitoring in septic shock. Curr Opin Crit Care 2012,18(3):280–286. 10.1097/MCC.0b013e3283532c08CrossRefPubMed
63.
Vincent JL, Ince C, Bakker J: Clinical review: circulatory shock - an update: a tribute to Professor Max Harry Weil. Crit Care 2012,16(6):239.PubMedCentralPubMed
64.
Polonen P, Ruokonen E, Hippelainen M, Poyhonen M, Takala J: A prospective, randomized study of goal-oriented hemodynamic therapy in cardiac surgical patients. Anesth Analg 2000,90(5):1052–1059. 10.1097/00000539-200005000-00010CrossRefPubMed
65.
Jones AE, Shapiro NI, Trzeciak S, Arnold RC, Claremont HA, Kline JA: Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA 2010,303(8):739–746. 10.1001/jama.2010.158PubMedCentralCrossRefPubMed
66.
Jansen TC, van Bommel J, Schoonderbeek FJ, Sleeswijk Visser SJ, van der Klooster JM, Lima AP, Willemsen SP, Bakker J: 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. 10.1164/rccm.200912-1918OCCrossRefPubMed
67.
James JH, Luchette FA, McCarter FD, Fischer JE: Lactate is an unreliable indicator of tissue hypoxia in injury or sepsis. Lancet 1999,354(9177):505–508. 10.1016/S0140-6736(98)91132-1CrossRefPubMed
68.
Vincent JL, Dufaye P, Berre J, Leeman M, Degaute JP, Kahn RJ: Serial lactate determinations during circulatory shock. Crit Care Med 1983,11(6):449–451. 10.1097/00003246-198306000-00012CrossRefPubMed
69.
Lewis RJ: Disassembling goal-directed therapy for sepsis: a first step. JAMA 2010,303(8):777–779. 10.1001/jama.2010.203CrossRefPubMed
70.
Zhang H, Spapen H, Benlabed M, Vincent JL: Systemic oxygen extraction can be improved during repeated episodes of cardiac tamponade. J Crit Care 1993,8(2):93–99. 10.1016/0883-9441(93)90013-BCrossRefPubMed
71.
Spronk PE, Ince C, Gardien MJ, Mathura KR, Oudemans-van Straaten HM, Zandstra DF: Nitroglycerin in septic shock after intravascular volume resuscitation. Lancet 2002,360(9343):1395–1396. 10.1016/S0140-6736(02)11393-6CrossRefPubMed
72.
Lima A, van Genderen M, Van Bommel J, Bakker J: Nitroglycerine dose-dependent improves peripheral perfusion in patients with circulatory shock: results of a prospective cross-over study. Intensive Care Med 2012,38(Suppl 1):S127.
73.
Boerma EC, Koopmans M, Konijn A, Kaiferova K, Bakker AJ, van Roon EN, Buter H, Bruins N, Egbers PH, Gerritsen RT: Effects of nitroglycerin on sublingual microcirculatory blood flow in patients with severe sepsis/septic shock after a strict resuscitation protocol: a double-blind randomized placebo controlled trial. Crit Care Med 2010,38(1):93–100. 10.1097/CCM.0b013e3181b02fc1CrossRefPubMed
74.
Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M: Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001,345(19):1368–1377. 10.1056/NEJMoa010307CrossRefPubMed
Metadata
Title
Clinical use of lactate monitoring in critically ill patients
Authors
Jan Bakker
Maarten WN Nijsten
Tim C Jansen
Publication date
01-12-2013
Publisher
Springer Paris
Published in
Annals of Intensive Care / Issue 1/2013
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/2110-5820-3-12

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