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.
KeywordsLactate Shock Circulatory dysfunction Hypoperfusion Hypoxia Monitoring Prognosis Lactate clearance
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