Lactate reloaded–reevaluation of the importance of lactate monitoring in the management of adult sepsis in the emergency department

[摘要] For about a quarter of a century, monitoring lactate levels and/or lactate clearance has been an unquestionable cornerstone in sepsis management. The elevated lactate level appeared to be an independent predictor of mortality, and the consequent metabolic acidosis was thought to explain a number of pathophysiological changes seen in septic shock. Recent physiological and clinical findings seem to challenge the adverse role of lactic acidosis in sepsis. Evidence suggests that lactate levels are not necessarily directly proportional to either tissue or cellular hypoxia, and conversely, despite high lactate levels, increased peripheral tissue oxygen pressure can be measured in adult patients with septic shock. According to the most recent understanding of in vitro and in vivo evidence, the elevated lactate level in sepsis might be a normal reaction due to adrenergic stress with potential beneficial/protective physiological effects, as well. On the one hand, burning lactic may help fuel the body during critical illness, but on the other hand, with a slight drop in pH, the body may counteract certain deleterious changes during the dysregulated host response; reduce the chances of reperfusion myocardial injury, and improve tissue oxygenation by shifting the haemoglobin dissociation curve to the right. Understanding the pathophysiological process in sepsis resulting in elevated lactate levels may aid management in an emergency, medicine, and intensive care settings. With more in-depth physiological knowledge, physicians may inevitably surpass normalisation heuristics and deliver personalized rather than protocolised sepsis resuscitation.

[学科分类] 仪器

[关键词] Reevaluation;Lactate;Sepsis;Resuscitation