Lactate: early predictor of morbidity and mortality in patients with severe burns

A severe burn results in a devastating and unique derangement called burn shock. Historically, resuscitation has been guided by a combination of basic laboratory values, invasive monitoring and clinical findings, but the optimal guide to the endpoint of resuscitation remains controversial. One-hundred sixty-six patients, who were admitted to our Burn Unit, were enrolled in this prospective study. Resuscitation of these patients was undertaken according to the current standard of care. Parkland formula was used as a first approximation of acquired fluid administration rates and fluid administration was adapted in order to meet clinical needs. The aim of this study was to evaluate if plasma lactate is a useful parameter to estimate the severity of a burn shock. One of the main objectives was to evaluate, if the lactate clearance adds additional information. The results of this study indicate that the initial lactate level (Day 0) is a useful parameter to separate survivors from non-survivors. Moreover, a significant marker of shock and resuscitation was observed in evaluating the lactate clearance on Day 1. A better chance of survival occurs when resuscitation results in a lactate clearance to normal values within 24h (survival was 68% if the lactate reached normal values, compared to 32% if the lactate level remained supra-normal). In summary, we believe that measuring lactate and lactate clearance may help to detect critically injured patients either for adequacy of treatment, or selection of other therapeutic options.