Different variables measured in critically ill patients have been used to estimate the severity of the disease, prognosticate morbidity and mortality, evaluate costs of treatment, and indicate specific treatment and monitor the adequacy of treatment and its timing. It is rare for one measurement to be able to replace all of these, but in this article, Bakker et al. will show that lactate monitoring may come close.

Hyperlactataemia (increased blood lactate levels) is common in critically ill patients. Even though it is often 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 patients suffering from hyperlactataemia, so lactate monitoring is essential.

In order to understand the importance of an increased lactate level, it is essential not only to consider anaerobic production but also aerobic mechanisms and changes in lactate clearance. Despite this complex evaluation, increased lactate levels usually reflect an increased morbidity and high mortality.

Two recent multicentre trials suggest that the use of lactate levels in goal-directed therapy may improve the clinical outcome of critically ill patients. According to Bakker et al., authors of this study, it is very important to monitor lactate levels and to adjust the treatment to the change in lactate levels in early resuscitation.

As a conclusion, Bakker et al. confirm that lactate monitoring is a valuable parameter in the early resuscitation of critically ill patients.

This article was written in English by Jan Bakker, Maarten WN Nijsten and Tim C Jansen, and was published back in 2013 in Annals of Intensive Care

Click here to download the complete article, written in English:
Clinical Use of Lactate Monitoring in Critically Ill Patients