title: Lactate as a hemodynamic marker in the critically ill.
abstract: OBJECTIVE
  An early quantitative resuscitation strategy improves outcome in critically ill patients. The hemodynamic endpoints of such a strategy have been a topic of debate in the literature. This review focuses on the use of lactate as a marker for risk stratification, lactate clearance as a hemodynamic endpoint, and its use compared to mixed venous oxygenation as a resuscitation goal.
  
  
  RESULTS
  Lactate clearance is associated with improved outcome across several cohorts of critically ill patients. Lactate levels and central venous oxygen saturations are frequently discordant. Targeting lactate clearance as part of a quantitative resuscitation strategy may be as effective as targeting central venous oxygen saturation.
  
  
  CONCLUSIONS
  Resuscitation of the critically ill patient should be aimed at the reversal of tissue hypoxia. The use of lactate as a hemodynamic marker and resuscitation endpoint makes physiologic sense, and is supported by the recent data. The use of lactate clearance versus other traditional endpoints of resuscitation, such as mixed venous oxygen saturation, should be based on the clinical characteristics and response of the individual patient.
authors.affiliation: Division of Critical Care, Department of Anesthesiology, Washington University in St. Louis, St. Louis, Missouri, USA. fullerb@wusm.wustl.edu
authors.forename: Brian M
authors.initials: BM
authors.lastname: Fuller
authors.forename: R Phillip
authors.initials: RP
authors.lastname: Dellinger
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D015331:Cohort Studies; D016638:Critical Illness; D006439:Hemodynamics; D006801:Humans; D019344:Lactic Acid / Q000145:classification / Q000378:metabolism*; D012151:Resuscitation / Q000379:methods*; D018570:Risk Assessment
chemical_list: D015415:Biomarkers; D019344:Lactic Acid