Comparison of blood lactate concentrations in central venous, pulmonary artery, and arterial blood

Arterial blood lactate is regarded as a very good indicator of the severity and prognosis of circulatory shock. Accordingly, the practical issue of whether such measurements might be equally valid on blood sampled from the right atrium or superior vena cava or from the pulmonary artery was investigated. In blood sampled prospectively on 50 occasions in 12 patients (group 1), arterial blood lactate ranged from 0.39 to 9.71 mmol/L. A very high correlation (r = .995) was observed between blood sampled simultaneously from an arterial and central venous catheter. The maximum absolute difference was 0.5, and mean difference 0.029 mmol/L. Comparable correlations were obtained between arterial and simultaneously sampled pulmonary artery blood (r = .994). We analyzed retrospectively the results of lactate analyses on 104 paired blood samples from the pulmonary artery and peripheral artery in 23 critically ill and injured patients (group 2) whose arterial blood lactates ranged from 0.46 to 12.99 mmol/L. We also found a high correlation (r = .998) between arterial and simultaneously sampled pulmonary artery blood lactate. The maximum absolute difference was 0.82, and the mean difference 0.03 mmol/L. These data demonstrate that lactate measurements in venous blood sampled either from a pulmonary artery or from a central venous catheter yield lactate concentrations essentially equivalent to those in arterial blood.