Part of the Lessons from the ICU book series (LEICU)


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.


Lactate Shock Circulatory dysfunction Hypoperfusion Hypoxia Monitoring Prognosis Lactate clearance 


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Copyright information

© European Society of Intensive Care Medicine 2019

Authors and Affiliations

  1. 1.Departamento de Medicina Intensiva, Facultad de MedicinaPontificia Universidad Católica de ChileSantiagoChile

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