Lactate is an unreliable indicator of tissue hypoxia in injury or sepsis

James, J. Howard; Luchette, Fred A.; McCarter, Freda D; Fischer, Josef E.

doi:10.1016/s0140-6736(98)91132-1

Cited by 468 publications

(269 citation statements)

References 38 publications

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“…Although there are reports that admission hyperlactatemia predicts mortality and clinical outcome, the predictive value of a single lactate assessed on admission is controversial. Several studies have shown no significant predictive value of admission lactate [23][24]. Recent reports offer to follow the upward or downward trend in lactate, or the duration of hyperlactatemia, by serial measurement after admission.…”

Section: Discussionmentioning

confidence: 99%

The reasons of hyperlactatemia on admission and relationship of the lactate levels with clinical outcomes in pediatric intensive care unit

Bağ¹,

Karaarslan²,

İşgüder³

et al. 2017

Pau Med J

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Purpose:Hyperlactatemia has been reported to predict mortality and morbidity in critically ill patients. The aim of this study is to define the reasons of hyperlactatemia on admission in critical pediatric patients, to describe a cut off value to predict mortality and to evaluate the outcomes of admission hyperlactatemia in pediatric intensive care unit. Materials and methods: Hospital records of 202 pediatric patients who had admitted to pediatric intensive care unit (Male/Female: 101/101; median age: 3 years [IQR: 9.2] ) were evaluated retrospectively, for the study. Age, gender, admission diagnosis, arterial blood gas analysis, length of stay, presence of in-hospital mortality were recorded in the study group. Hyperlactatemia was defined according to L-lactate levels defined by age. The patients with and without hyperlactatemia were compared for mortality and clinical outcomes. Results:The frequency of admission hyperlactatemia was 64.3% (n: 130). The patients with dehydration due to acute gastroenteritis, acute respiratory insufficiency and acaute cardiac insufficiency had significantly higher lactate levels compared with children with other diagnosis. Admission hyperlactatemia was not found to have a cut-off value to predict mortality by ROC analysis (Area under curve: 0.57). Moreover, hyperlactatemia was not found to effect either mortality rate or outcome in the study group. Conclusion:The results of this study indicate that admission hyperlactatemia may not be used as a predictor of either death or poor clinical outcome in pediatric intensive care units. Further there is a lack of cut off value for lactate in literature to predict outcomes in different pediatric ages. Pam Med J 2017;(1):1-6Key words: Hyperlactatemia, admission, childhood, PICU. ÖzetAmaç: Laktat yüksekliğinin kritik hasta izleminde mortalite ve morbiditeyi belirleyici olduğunu gösteren çalişmalar mevcuttur. Bu araştirmanin amaci, kritik hastaliği olan çocuklarda laktat yüksekliğinin nedenlerini belirlemek, mortaliteyi belirleyen bir eşik değer olup olmadiğini saptamak ve çocuk yoğun bakim ünitesinde laktat yüksekliğinin klinik sonuçlarini değerlendirmektir. Gereç ve yöntem: Çocuk yoğun bakim ünitesine başvuran toplam 202 olgunun (Erkek/Kiz: 101/101; median yaş: 3 [IQR: 9.2]) dosya kayitlari geriye dönük olarak incelendi. Hastalarin yaşi, cinsiyeti, başvuru tanisi, arteriyel kan gazi sonuçlari, hastanede kalma süresi, ve ölüm varliği kaydedildi. Laktat yüksekliği, yaş gruplarina göre düzeylerine göre tanimlandi. Başvuruda laktat yüksekliği olan ve olmayan olgular, ölüm oranlari ve klinik sonuçlar açisindan karşilaştirildi. Bulgular: Başvuruda saptanan hiperlaktatemi sikliği %64.3 (n: 130) idi. Akut gastroenterite bağli dehidratasyon, akut solunumsal yetmezlik ve akut kalp yetmezliği olanlarda laktat düzeyleri diğer tanilarla karşilaştirildiğinda anlamli olarak daha yüksek bulundu. ROC analizi ile mortaliteyi belirleyecek herhangi bir eşik değer saptanmadi (eğri alti alan: 0.57). Ayrica, hiperlaktateminin mortalite ve klinik sonuçla...

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Section: Discussionmentioning

confidence: 99%

The reasons of hyperlactatemia on admission and relationship of the lactate levels with clinical outcomes in pediatric intensive care unit

Bağ¹,

Karaarslan²,

İşgüder³

et al. 2017

Pau Med J

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“…Desta forma, presume-se que os mecanismos neuroendócrinos fisioló-gicos do estresse, principalmente da ativação do sistema nervoso adrenérgico em virtude do atendimento ambulatorial, fazem a liberação das catecolaminas endógenas, que promovem inotropismo e cronotropismo positivos, vasoconstrição periférica, aumento da pressão arterial e no consumo e demanda da oxigenação e energia celular (Acco et al 1999, Belettini 2008. James et al (1999), descreveram aumento da produção de lactato quando referiram que a liberação da adrenalina endógena promove o aumento da glicólise aeróbica, em virtude de estimular a bomba de Na+/-K ATPase celular. Além disso, a contenção física dos cães e a oclusão venosa realizada para a cateterização podem sugerir a elevação discreta do lactato sérico, devido ao aumento na atividade muscular e a lise eritrocitária (Hughes 2000, De Backer et al 2006; sistemas responsá- veis por 20 a 25% da produção do lactato sérico fisiológico orgânico (Okorie & Dellinger 2011).…”

Section: Discussionunclassified

Valores de lactato sérico e sua correlação com parâmetros clínicos de cães saudáveis, mensurados durante atendimento ambulatorial veterinário

et al. 2016

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ABSTRACT.-Franco R.P., Massufaro C.R., Martineli J., Girotto C.H., Hirota I.N., Zache E. & Hataka A. 2016 The measurement of serum lactate is used in the medical routine as a prognosis marker of emergency patients. Its interpretation should not be done disconnectedly from the other clinical parameters once metabolical or environmental stress as well as restraint and/or manipulation of patients can interfere. Thus we tried to measure the levels of serum lactate and clinical parameters of healthy dogs, as their correlation during veterinarian outpatient clinical care. For that we evaluated 80 dogs, males and females, with age ranging from one to eight years, met for polyvalent annual revaccination. We considered to be healthy those dogs that had no clinical events in the last 60 days or alteration in physical exams, blood exam values and serum glycemia. We initially measured body weight, heart rate (HR) and respiratory (RR), capillary refill time, mucosa's coloring, rectal temperature (RT), peripheral temperature (PT) and the difference between RT and PT, Delta T°C. Finally we did the blood exam and the serum glycemia, as well as the serum lactate measurement. For that we used a portable lactimeter, using the blood sample taken from the cephalic vein. Furthermore, when there was correlation between the serum lactate values and the body weight, we divided the dogs according to the calculation of 33 and 66 percentile. Evaluated dogs showed average values of 18.3±12.1 kg of body weight and 3.0±1.9 of age; with HR of 126.6±29.1bpm, RR of 66±24mpm, RT of 38.9±0.4°C, PT of 31.5±1,0°C, Delta T°C of 7.3±1.0°C and serum lactate of 3.2±0.4mmol/L; with the latter showing range of 3.1-3.3mmol/L with 95% of reliability and significant correlation (p<0.05) between its values and the body weight (r=0.6) and the heart rate (r=0.4). The serum lactate values obtained were compared between the dogs' groups according to their body weight, showing distinguished differences between them. Thereby we concluded that the serum lactate values in dogs under outpatient care is 3.2mmol/L, with a trust gap of 3.1-3.3mmol/L, highlighting the influence that HR and body weight can have on its values.INDEX TERMS: Serum lactate, clinical parameters, dogs.

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“…We analyzed the effects of capillary flow disturbance on oxygen uptake, glucose uptake, and ATP production in tumor and brain tissue,84, 85 and discovered that the uptake of glucose becomes limited, yet remains favored over that of oxygen, as CTH increases. Further studies should therefore address whether microcirculatory disturbances contribute to the hyperglycemia,86 aerobic glycolysis,87 and lactate production88, 89 observed in sepsis.…”

Section: Other Organs and Other Metabolitesmentioning

confidence: 99%

Microcirculatory dysfunction and tissue oxygenation in critical illness

Østergaard

Granfeldt

Secher

et al. 2015

Acta Anaesthesiol Scand

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Severe sepsis is defined by organ failure, often of the kidneys, heart, and brain. It has been proposed that inadequate delivery of oxygen, or insufficient extraction of oxygen in tissue, may explain organ failure. Despite adequate maintenance of systemic oxygen delivery in septic patients, their morbidity and mortality remain high.The assumption that tissue oxygenation can be preserved by maintaining its blood supply follows from physiological models that only apply to tissue with uniformly perfused capillaries. In sepsis, the microcirculation is profoundly disturbed, and the blood supply of individual organs may therefore no longer reflect their access to oxygen.We review how capillary flow patterns affect oxygen extraction efficacy in tissue, and how the regulation of tissue blood flow must be adjusted to meet the metabolic needs of the tissue as capillary flows become disturbed as observed in critical illness. Using the brain, heart, and kidney as examples, we discuss whether disturbed capillary flow patterns might explain the apparent mismatch between organ blood flow and organ function in sepsis. Finally, we discuss diagnostic means of detecting capillary flow disturbance in animal models and in critically ill patients, and address therapeutic strategies that might improve tissue oxygenation by modifying capillary flow patterns.

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Lactate is an unreliable indicator of tissue hypoxia in injury or sepsis

Cited by 468 publications

References 38 publications

The reasons of hyperlactatemia on admission and relationship of the lactate levels with clinical outcomes in pediatric intensive care unit

The reasons of hyperlactatemia on admission and relationship of the lactate levels with clinical outcomes in pediatric intensive care unit

Valores de lactato sérico e sua correlação com parâmetros clínicos de cães saudáveis, mensurados durante atendimento ambulatorial veterinário

Microcirculatory dysfunction and tissue oxygenation in critical illness

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