Evaluation of a new, rapid lactate analyzer in critical care.
OBJECTIVE
To determine the reliability, precision and clinical usefulness of a newly developed substrate-specific lactate/blood gas analyzer (Chiron M865).


METHODS
A university hospital 31-bed mixed medical/surgical intensive care unit (ICU).


METHODS
Seventeen critically ill patients with sepsis (n = 4), post-cardiac surgery (n = 8), hepatic failure (n = 2) or acute respiratory failure (n = 3).


RESULTS
Lactate levels were measured in 17 critically ill patients on whole blood using the new Chiron M865, and on plasma by a stat lactate/glucose analyzer (Yellow Spring Instrument, YSI mode 2300) and a reference lactate/glucose/electrolyte/enzyme analyzer (Hitachi 911). The influences of temperature and storage on blood lactate levels were then evaluated. Mean lactate values obtained were 3.73+/-2.84 mmol/l with the Chiron, 3.03+/-2.60 mmol/l with the YSI, and 3.59+/-2.92 mmol/l with the Hitachi. There was a strong correlation between the three analyzers (Chiron vs YSI r = 0.99; Chiron vs Hitachi 911 r = 0.98), and good agreement between the Chiron and the two other methods (Chiron/YSI bias was -0.65, SD 0.50 mmol/l; Chiron/Hitachi bias was 0.12, SD 0.55 mmol/l). The variability coefficients were 3.7% for the Chiron and 3.0% for the YSI. During short term storage, a continuous increase in lactate levels was observed at room temperature (2.36+/-1.68 mmol/l to 2.53+/-1.74 mmol/l, p < 0.05), but when the samples were kept on ice there was just a small statistically significant, but not clinically significant, increase after 8 min (2.37+/-1.62 mmol/l to 2.39+/-1.63 mmol/l, p < 0.05). For longer storage times, samples on ice showed a small increase in lactate levels after 15 min (3.73+/-2.90 mmol/l to 4.01+/-3.00 mmol/l, p < 0.05) but no further increase during the subsequent 45 min.


CONCLUSIONS
The new Chiron lactate analyzer is reliable for serial whole blood lactate measurements in an intensive care stat laboratory. Samples should be kept on ice immediately after sampling to minimize in vitro erythrocyte production of lactate.
Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Belgium.
O
O
Noordally
J L
JL
Vincent
D000140:Acidosis, Lactic / Q000175:diagnosis*; D000704:Analysis of Variance; D001784:Blood Gas Analysis / Q000295:instrumentation*; D006801:Humans; D007362:Intensive Care Units; D019344:Lactic Acid / Q000097:blood*; D015203:Reproducibility of Results
D019344:Lactic Acid