Early Lactate-Guided Therapy in Intensive Care Unit Patients

Abstract

In patients with hyperlactatemia on ICU admission, lactate-guided therapy significantly reduced hospital mortality when adjusting for predefined risk factors. As this was consistent with important secondary endpoints, this study suggests that initial lactate monitoring has clinical benefit. Clinical trial registered with www.clinicaltrials.gov (NCT00270673).

Can we find accessible and relevant markers for sepsis outcome?

“…(32) Londono et al proved that mortality increased in a linear way with serum lactate and Jansen et al concluded that reduction with 20% per 2 hours of serum lactate value is correlated with significant reduction of mortality. (33)(34)(35) We can conclude we found out that serum lactate is an independent parameter correlated with mortality in septic patients as other studies show.…”

Early evaluation of severity in patients with severe sepsis: a comparison with “septic shock” — subgroup analysis of the Japanese Association for Acute Medicine Sepsis Registry (JAAM‐SR)

“…Therefore, lactate values themselves, their clearances, or clearance rates during certain intervals have often been reported to be useful for evaluating systemic tissue oxygenation and for predicting patient outcome 5, 6, 7, 10, 11, 12. Aduen et al .…”

“…adopted hypotension or lactate values ≥4 mmol/L after adequate fluid resuscitation as selection criteria for critically ill patients in their 2001 paper in which they proposed EGDT 5. More recently, there have been several papers reporting that an improvement in outcome could be realized for critical patients with diseases such as severe sepsis by navigating therapy using lactate clearance in the early resuscitation phase 6, 7, 10…”

“…proposed “early goal‐directed therapy” (EGDT) in 2001 and reported a remarkable reduction in mortality rate if several “early goals” were all fulfilled 5. Since the publication of Rivers' paper, there have been many reports that have described the beneficial and promising effects of a modified EGDT 6, 7…”

“…However, other candidates for severity predictors have also been studied widely. Among them, serum lactate, which is a sensitive indicator of systemic tissue oxygenation, has been reported to be a useful marker of patient outcomes with a wide variety of severe diseases, not only for patients with severe sepsis 7, 10, 11, 12…”