Lactate kinetics in critically ill: a new prognostic marker or just another brick in the wall?

Excerpt

In this issue of the journal, Masyuk et al. publish another piece of the lactate story [1]. The Surviving Sepsis Campaign has suggested to use lactate normalization as a goal for septic shock resuscitation in patients with hyperlactatemia, although with a low quality of supporting evidence [2]. Indeed, besides hypoperfusion, other sources such as stress-related hyperlactatemia might contribute to persistent hyperlactatemia [3]. Moreover, conflicting results have been reported so far about the efficacy of resuscitation strategies based on serial blood lactate assessments and/or lactate kinetics. One non-inferiority randomized controlled trial (RCT) showed no difference of mortality in 300 septic patients when compared to a strategy based on ScVO₂ [4], while another one including 348 unselected patients with an admission blood lactate ≥ 3 mmol/L reported a beneficial effect on in-hospital mortality, specifically in septic patients [5]. Oddly, in the latter study the authors did not report any lactate kinetics difference during the first 72 h between control and interventional arms despite an “aggressive” approach in the interventional group [5]. …