title: Lactate kinetics in sepsis and septic shock: a review of the literature and rationale for further research.
abstract: Over the last two decades, there have been vast improvements in sepsis-related outcomes, largely resulting from the widespread adoption of aggressive fluid resuscitation and infection control. With increased understanding of the pathophysiology of sepsis, novel diagnostics and resuscitative interventions are being discovered. In recent years, few diagnostic tests like lactate have engendered more attention and research in the sepsis arena. Studies highlighting lactate's prognostic potential for mortality and other outcomes are ubiquitous and largely focus on the early stage of sepsis management, defined as the initial 6 h and widely referred to as the "golden hours." Additional investigations, although more representative of surgical and trauma patients, suggest that lactate measurements beyond 24 h from the initiation of resuscitation continue to have predictive and prognostic utility. This review summarizes the current research and evidence regarding lactate's utility as a prognosticator of clinical outcomes in both early and late sepsis management, defines the mechanism of lactate production and clearance, and identifies areas warranting further research.
authors.affiliation: Department of Medicine, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32608 USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Chertoff
authors.affiliation: Department of Medicine, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32608 USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Chisum
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care, University of Alabama-Birmingham, Birmingham, AL USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Garcia
authors.affiliation: Division of Pulmonary Critical Care, University of Florida, Gainesville, FL USA.
authors.forename: Jorge
authors.initials: J
authors.lastname: Lascano
keywords: Early sepsis; Kinetics; Lactate; Late sepsis; Microvascular; Resuscitation; Sepsis; Shock