English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

An increased blood lactate level is widely believed to be a marker of inadequate oxygen delivery and anaerobic metabolism. Furthermore, the rate of decline in lactate concentration (lactate clearance) has been recommended as an end-point of early goal directed therapy in critical ill patients with sepsis. We provide compelling data that an elevated lactate concentration is a consequence of increased aerobic glycolysis as part of the stress response and that titrating therapy to the rate of decline in lactate concentration is a potentially harmful endeavour. Furthermore, an increased lactate concentration may be an important adaptive survival response during critical illness. Conclusion An elevated lactate concentration in patients with sepsis is a marker of disease severity and not an indication of anaerobic metabolism. Increasing oxygen delivery to treat a non-existent oxygen debt may be a harmful undertaking. ‘Lactate clearance’ should not be used as the end-point of resuscitation in patients with sepsis. Introduction It is widely believed that in critically ill patients when oxygen delivery fails to meet oxygen demand an oxygen debt with global tissue hypoxia ensues1–2. This results in anaerobic metabolism and increased lactate production1–2. An increased blood lactate concentration is therefore regarded as irrefutable evidence of anaerobic metabolism and tissue hypoxia1. Nguyen reported that ‘lactate clearance’, defined as the percentage decrease in lactate from emergency department presentation to 6h, was an independent predictor of mortality1.They concluded that ‘lactate clearance in the early hospital course may indicate a resolution of global tissue hypoxia and that this is associ-ated with decreased mortality rates.’ This study popularized the concept of ‘lactate clearance’ and has led to a number of studies which have used ‘lactate clearance’ as the major end-point of haemodynamic resuscitation in critically in patients with sepsis3–5. In this paper we demonstrate that this logic is scientifically flawed and that attempting to titrate therapy to a blood lactate level may be harmful. We suggest that the degree of elevation of the blood lactate is a reflection of the severity of illness and the degree of activation of the stress response (and release of epinephrine) rather than being a marker of an-aerobic metabolism. Furthermore, an increased lactate concentration may be an important adaptive survival response during critical illness.

Lactate clearance as a target of therapy in sepsis: A flawed paradigm