Skip to main content
SpringerLink
Log in

Lactate

  • Chapter
Hemodynamic Monitoring

Part of the book series: Lessons from the ICU ((LEICU))

  • 4082 Accesses

Abstract

Lactate is a key metabolic parameter that has traditionally been related to hypoperfusion and hypoxia during acute circulatory dysfunction. Lactate assessment is recommended as a fundamental part of the monitoring of the critically ill patient.

Persistent hyperlactatemia after shock resuscitation is associated to increased morbidity and mortality but is particularly difficult to interpret in the clinical setting. At least three possible pathogenic mechanisms might be involved: anaerobic glycolysis in hypoperfused territories, stress-related adrenergic-induced aerobic glycolysis, and impaired hepatic lactate clearance. A multimodal perfusion assessment might aid in suggesting a hypoperfusion context in patients with persistent hyperlactatemia to focus resuscitation in these cases and avoid the risk of over-resuscitation when other non-perfusion-related causes are likely involved.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Hernandez G, Bruhn A, Castro R, Regueira T. The holistic view on perfusion monitoring in septic shock. Curr Opin Crit Care. 2012;18:280–6.

    PubMed  Google Scholar 

  2. Bakker J, Nijsten MW, Jansen TC. Clinical use of lactate monitoring in critically ill patients. Ann Intensive Care. 2013;3:12.

    PubMed  PubMed Central  Google Scholar 

  3. Bakker J, Vincent JL. The oxygen-supply dependency phenomenon is associated with increased blood lactate levels. J Crit Care. 1991;6:152–9.

    Google Scholar 

  4. Bakker J, Coffernils M, Leon M, Gris P, Vincent JL. Blood lactate levels are superior to oxygen-derived variables in predicting outcome in human septic shock. Chest. 1991;99:956–62.

    CAS  Google Scholar 

  5. Nguyen HB, Rivers EP, Knoblich BP, Jacobsen G, Muzzin A, Ressler JA, et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med. 2004;32:1637–42.

    Google Scholar 

  6. Arnold RC, Shapiro NI, Jones AE, Schorr C, Pope J, Casner E, et al. Multicenter study of early lactate clearance as a determinant of survival in patients with presumed sepsis. Shock. 2009;32:35–9.

    CAS  Google Scholar 

  7. Mikkelsen ME, Miltiades AN, Gaieski DF, Goyal M, Fuchs BD, Shah CV, et al. Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock. Crit Care Med. 2009;37:1670–7.

    CAS  PubMed  Google Scholar 

  8. Gu WJ, Wang F, Bakker J, Tang L, Liu JC. The effect of goal-directed therapy on mortality in patients with sepsis - earlier is better: a meta-analysis of randomized controlled trials. Crit Care. 2014;18:570.

    PubMed  PubMed Central  Google Scholar 

  9. Jansen TC, van Bommel J, Schoonderbeek FJ, Visser SJS, van der Klooster JM, Lima AP, et al. Early lactate-guided therapy in intensive care unit patients: a multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med. 2010;182:752–61.

    Google Scholar 

  10. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315:801–10.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43:304–77.

    Google Scholar 

  12. Garcia-Alvarez M, Marik P, Bellomo R. Sepsis-associated hyperlactatemia. Crit Care. 2014;18:503.

    PubMed  PubMed Central  Google Scholar 

  13. Cori CF. Mammalian carbohydrate metabolism. Physiol Rev. 1931;11:143–275.

    CAS  Google Scholar 

  14. Levy B. Lactate and shock state: the metabolic view. Curr Opin Crit Care. 2006;12:315–21.

    PubMed  Google Scholar 

  15. Friedman G, De Backer D, Shahla M, Vincent JL. Oxygen supply dependency can characterize septic shock. Intensive Care Med. 1998;24:118–23.

    CAS  PubMed  Google Scholar 

  16. De Backer D, Donadello K, Sakr Y, Ospina-Tascon G, Salgado D, Scolletta S, et al. Microcirculatory alterations in patients with severe sepsis: impact of time of assessment and relationship with outcome. Crit Care Med. 2013;41:791–9.

    PubMed  Google Scholar 

  17. Hernandez G, Boerma EC, Dubin A, Bruhn A, Koopmans M, Edul VK, et al. Severe abnormalities in microvascular perfused vessel density are associated to organ dysfunctions and mortality and can be predicted by hyperlactatemia and norepinephrine requirements in septic shock patients. J Crit Care. 2013;28:538.e9–14.

    CAS  Google Scholar 

  18. Hernandez G, Bruhn A, Ince C. Microcirculation in sepsis: new perspectives. Curr Vasc Pharmacol. 2013;11:161–9.

    CAS  PubMed  Google Scholar 

  19. Ospina-Tascón GA, Umaña M, Bermúdez W, Bautista-Rincón DF, Hernandez G, Bruhn A, et al. Combination of arterial lactate levels and venous-arterial CO2 to arterial-venous O2 content difference ratio as markers of resuscitation in patients with septic shock. Intensive Care Med. 2015;41:796–805.

    PubMed  PubMed Central  Google Scholar 

  20. Rimachi R, Bruzzi de Carvahlo F, Orellano-Jimenez C, Cotton F, Vincent JL, De Backer D. Lactate/pyruvate ratio as a marker of tissue hypoxia in circulatory and septic shock. Anaesth Intensive Care. 2012;40:427–32.

    CAS  PubMed  Google Scholar 

  21. Ospina-Tascón GA, Hernández G, Cecconi M. Understanding the venous-arterial CO2 to arterial-venous O2 content difference ratio. Intensive Care Med. 2016;42:1801–4.

    PubMed  Google Scholar 

  22. Monnet X, Julien F, Ait-Hamou N, Lequoy M, Gosset C, Jozwiak M, et al. Lactate and venoarterial carbon dioxide difference/arterial-venous oxygen difference ratio, but not central venous oxygen saturation, predict increase in oxygen consumption in fluid responders. Crit Care Med. 2013;41:1412–20.

    CAS  PubMed  Google Scholar 

  23. Minton J, Sidebotham DA. Hyperlactatemia and cardiac surgery. J Extra Corpor Technol. 2017;49:7–15.

    PubMed  PubMed Central  Google Scholar 

  24. Levy B, Desebbe O, Montemont C, Gibot S. Increased aerobic glycolysis through beta2 stimulation is a common mechanism involved in lactate formation during shock states. Shock. 2008;30:417–21.

    CAS  PubMed  Google Scholar 

  25. 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;365:871–5.

    CAS  PubMed  Google Scholar 

  26. Vincent JL, Quintairos E, Silva A, Couto L Jr, Taccone FS. The value of blood lactate kinetics in critically ill patients: a systematic review. Crit Care. 2016;20:257.

    PubMed  PubMed Central  Google Scholar 

  27. Hernandez G, Regueira T, Bruhn A, Castro R, Rovegno M, Fuentealba A, et al. Relationship of systemic, hepatosplanchnic, and microcirculatory perfusion parameters with 6-hour lactate clearance in hyperdynamic septic shock patients: an acute, clinical-physiological, pilot study. Ann Intensive Care. 2012;2:44.

    PubMed  PubMed Central  Google Scholar 

  28. Mizock B. The hepatosplanchnic area and hyperlactatemia: a tale of two lactates. Crit Care Med. 2001;29:447–9.

    CAS  PubMed  Google Scholar 

  29. De Backer D, Creteur J, Silva E, Vincent JL. The hepatosplanchnic area is not a common source of lactate in patients with severe sepsis. Crit Care Med. 2001;29:256–61.

    PubMed  Google Scholar 

  30. Levraut J, Ciebiera JP, Chave S, Rabary O, Jambou P, Carles M, et al. Mild hyperlactatemia in stable septic patients is due to impaired lactate clearance rather than overproduction. Am J Respir Crit Care Med. 1998;157:1021–6.

    CAS  Google Scholar 

  31. Tapia P, Soto D, Bruhn A, Alegría L, Jarufe N, Luengo C, et al. Impairment of exogenous lactate clearance in experimental hyperdynamic septic shock is not related to total liver hypoperfusion. Crit Care. 2015;19:188.

    PubMed  PubMed Central  Google Scholar 

  32. Hernández G, Tapia P, Alegría L, Soto D, Luengo C, Gomez J, et al. Effects of dexmedetomidine and esmolol on systemic hemodynamics and exogenous lactate clearance in early experimental septic shock. Crit Care. 2016;20:234.

    PubMed  PubMed Central  Google Scholar 

  33. Casserly B, Phillips GS, Schorr C, Dellinger RP, Townsend SR, Osborn TM, et al. Lactate measurements in sepsis-induced tissue hypoperfusion: results from the Surviving Sepsis Campaign database. Crit Care Med. 2015;43:567–73.

    CAS  Google Scholar 

  34. Kompanje EJO, 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;33:1967–71.

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Bakker J. Lost in translation: on lactate, hypotension, sepsis-induced tissue hypoperfusion, quantitative resuscitation and Surviving Sepsis Campaign bundles. Crit Care Med. 2015;43:705–6.

    PubMed  Google Scholar 

  36. Bakker J, de Backer D, Hernandez G. Lactate-guided resuscitation saves lives: we are not sure. Intensive Care Med. 2016;42:472–4.

    PubMed  Google Scholar 

  37. Hernández G, Teboul JL. Fourth Surviving Sepsis Campaign’s hemodynamic recommendations: a step forward or a return to chaos? Crit Care. 2017;21:133.

    PubMed  PubMed Central  Google Scholar 

  38. Vellinga NAR, Boerma EC, Koopmans M, Donati A, Dubin A, Shapiro NI, et al. Mildly elevated lactate levels are associated with microcirculatory flow abnormalities and increased mortality: a microSOAP post hoc analysis. Crit Care. 2017;21:255.

    PubMed  PubMed Central  Google Scholar 

  39. Jones AE, Shapiro NI, Trzeciak S, Arnold RC, Claremont HA, Kline JA, et al. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA. 2010;303:739–46.

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Puskarich MA, Trzeciak S, Shapiro NI, Albers AB, Heffner AC, Kline JA, et al. Whole blood lactate kinetics in patients undergoing quantitative resuscitation for severe sepsis and septic shock. Chest. 2013;143:1548–53.

    CAS  PubMed  Google Scholar 

  41. Hernandez G, Luengo C, Bruhn A, Kattan E, Friedman G, Ospina-Tascon GA, et al. When to stop septic shock resuscitation: clues from a dynamic perfusion monitoring. Ann Intensive Care. 2014;4:30.

    PubMed  PubMed Central  Google Scholar 

  42. Vallée F, Vallet B, Mathe O, Parraguette J, Mari A, Silva S, et al. Central venous-to-arterial carbon dioxide difference: an additional target for goal-directed therapy in septic shock? Intensive Care Med. 2008;34:2218–25.

    PubMed  Google Scholar 

  43. Lara B, Enberg L, Ortega M, Leon P, Kripper C, Aguilera P, et al. Capillary refill time during fluid resuscitation in patients with sepsis-related hyperlactatemia at the emergency department is related to mortality. PLoS One. 2017;12:e0188548.

    PubMed  PubMed Central  Google Scholar 

  44. Alegría L, Vera M, Dreyse J, Castro R, Carpio D, Henriquez C. A hypoperfusion context may aid to interpret hyperlactatemia in sepsis-3 septic shock patients: a proof-of-concept study. Ann Intensive Care. 2017;7:29.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile

    Ricardo Castro, David Carpio & Glenn Hernández

Authors
  1. Ricardo Castro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Carpio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Glenn Hernández
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Critical Care Medicine Dept., University of Pittsburgh, Pittsburgh, PA, USA

    Michael R. Pinsky

  2. Bicetre University Hospital, Paris South University, Le Kremlin-Bicêtre, France

    Jean-Louis Teboul

  3. Department of Intensive Care, Erasme University Hospital, Brussels, Belgium

    Jean-Louis Vincent

Rights and permissions

Reprints and permissions

Copyright information

© 2019 European Society of Intensive Care Medicine

About this chapter

Cite this chapter

Castro, R., Carpio, D., Hernández, G. (2019). Lactate. In: Pinsky, M.R., Teboul, JL., Vincent, JL. (eds) Hemodynamic Monitoring. Lessons from the ICU. Springer, Cham. https://doi.org/10.1007/978-3-319-69269-2_17

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-69269-2_17

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-69268-5

  • Online ISBN: 978-3-319-69269-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation