Blood lactate monitoring in critically ill patients: a systematic health technology assessment.
OBJECTIVE
To decide whether the use of blood lactate monitoring in critical care practice is appropriate. We performed a systematic health technology assessment as blood lactate monitoring has been implemented widely but its clinical value in critically ill patients has never been evaluated properly.


METHODS
PubMed, other databases, and citation review.


METHODS
We searched for lactate combined with critically ill patients as the target patient population. Two reviewers independently selected studies based on relevance for the following questions: Does lactate measurement: 1) perform well in a laboratory setting? 2) provide information in a number of clinical situations? 3) relate to metabolic acidosis? 4) increase workers' confidence? 5) alter therapeutic decisions? 6) result in benefit to patients? 7) result in similar benefits in your own setting? 8) result in benefits which are worth the extra costs?


METHODS
We concluded that blood lactate measurement in critically ill patients: 1) is accurate in terms of measurement technique but adequate understanding of the (an)aerobic etiology is required for its correct interpretation; 2) provides not only diagnostic but also important prognostic information; 3) should be measured directly instead of estimated from other acid-base variables; 4) has an unknown effect on healthcare workers' confidence; 5) can alter therapeutic decisions; 6) could potentially improve patient outcome when combined with a treatment algorithm to optimize oxygen delivery, but this has only been shown indirectly; 7) is likely to have similar benefits in critical care settings worldwide; and 8) has an unknown cost-effectiveness.


CONCLUSIONS
The use of blood lactate monitoring has a place in risk-stratification in critically ill patients, but it is unknown whether the routine use of lactate as a resuscitation end point improves outcome. This warrants randomized controlled studies on the efficacy of lactate-directed therapy.
Jansen
Tim C
TC
Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, Netherlands.
van Bommel
Jasper
J
Bakker
Jan
J
D000140:Acidosis, Lactic / Q000097:blood / Q000175:diagnosis / Q000628:therapy; D000465:Algorithms; D003422:Critical Care; D003661:Decision Support Techniques; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D010102:Oxygen Inhalation Therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D012151:Resuscitation; D018805:Sepsis / Q000097:blood* / Q000628:therapy; D013673:Technology Assessment, Biomedical; D016896:Treatment Outcome
D019344:Lactic Acid