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Lactate as a hemodynamic marker in the critically ill
Brian M Fuller1, R Phillip Dellinger
1Division of Critical Care, Department of Anesthesiology, Washington University in St. Louis, St. Louis, Missouri, USA. fullerb@wusm.wustl.edu
Current Opinion in Critical Care
|April 21, 2012
Summary
Early quantitative resuscitation using lactate clearance improves outcomes in critically ill patients. This strategy may be as effective as targeting central venous oxygen saturation for better patient results.
Area of Science:
- Critical Care Medicine
- Hemodynamics
- Biomarkers
Background:
- Early quantitative resuscitation strategies are vital for critically ill patients.
- Hemodynamic endpoints for resuscitation remain a subject of debate.
- Lactate and mixed venous oxygenation are commonly discussed resuscitation goals.
Purpose of the Study:
- To review the use of lactate for risk stratification.
- To evaluate lactate clearance as a hemodynamic endpoint.
- To compare lactate clearance with mixed venous oxygenation as a resuscitation goal.
Main Methods:
- Literature review focusing on quantitative resuscitation strategies.
- Analysis of studies utilizing lactate and mixed venous oxygenation.
- Comparison of patient outcomes based on different resuscitation endpoints.
Main Results:
- Lactate clearance correlates with improved outcomes in critically ill patients.
- Lactate levels and central venous oxygen saturations often show discordance.
- Targeting lactate clearance may be as effective as targeting central venous oxygen saturation.
Conclusions:
- Resuscitation should aim to reverse tissue hypoxia.
- Lactate is a physiologically sound marker and endpoint for resuscitation.
- Choice between lactate clearance and other endpoints depends on individual patient factors.
