title: The use of finger-stick blood to assess lactate in critically ill surgical patients.
abstract: BACKGROUND
  Using finger-stick capillary blood to assess lactate from the microcirculation may have utility in treating critically ill patients. Our goals were to determine how finger-stick capillary lactate correlates with arterial lactate levels in patients from the surgical intensive care unit, and to compare how capillary and arterial lactate trend over time in patients undergoing resuscitation for shock.
  
  
  METHODS
  Capillary whole blood specimens were obtained from finger-sticks using a lancet, and assessed for lactate via a handheld point-of-care device as part of an "investigational use only" study. Comparison was made to arterial blood specimens that were assessed for lactate by standard laboratory reference methods.
  
  
  RESULTS
  40 patients (mean age 68, mean APACHEII 18, vasopressor use 62%) were included. The correlation between capillary and arterial lactate levels was 0.94 (p < 0.001). Capillary lactate measured slightly higher on average than paired arterial values, with a mean difference 0.99 mmol/L. In patients being resuscitated for septic and hemorrhagic shock, capillary and arterial lactate trended closely over time: rising, peaking, and falling in tandem. Clearance of capillary and arterial lactate mirrored clinical improvement, normalizing in all patients except two that expired.
  
  
  CONCLUSIONS
  Finger-stick capillary lactate both correlates and trends closely with arterial lactate in critically ill surgical patients, undergoing resuscitation for shock.
authors.affiliation: Division of Surgical-Critical Care, Department of Surgery, Icahn School of Medicine at Mount Sinai Beth Israel, First Avenue and 16th Street, New York, NY 10003, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Sabat
authors.affiliation: Division of Surgical-Critical Care, Department of Surgery, Icahn School of Medicine at Mount Sinai Beth Israel, First Avenue and 16th Street, New York, NY 10003, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Gould
authors.affiliation: Division of Surgical-Critical Care, Department of Surgery, Icahn School of Medicine at Mount Sinai Beth Israel, First Avenue and 16th Street, New York, NY 10003, USA.
authors.forename: Ezra
authors.initials: E
authors.lastname: Gillego
authors.affiliation: Division of Surgical-Critical Care, Department of Surgery, Icahn School of Medicine at Mount Sinai Beth Israel, First Avenue and 16th Street, New York, NY 10003, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Hariprashad
authors.affiliation: Division of Surgical-Critical Care, Department of Surgery, Icahn School of Medicine at Mount Sinai Beth Israel, First Avenue and 16th Street, New York, NY 10003, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Wiest
authors.affiliation: Division of Surgical-Critical Care, Department of Surgery, Icahn School of Medicine at Mount Sinai Beth Israel, First Avenue and 16th Street, New York, NY 10003, USA.
authors.forename: Shailyn
authors.initials: S
authors.lastname: Almonte
authors.affiliation: Division of Surgical-Critical Care, Department of Surgery, Icahn School of Medicine at Mount Sinai Beth Israel, First Avenue and 16th Street, New York, NY 10003, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Lucido
authors.affiliation: Division of Surgical-Critical Care, Department of Surgery, Icahn School of Medicine at Mount Sinai Beth Israel, First Avenue and 16th Street, New York, NY 10003, USA.
authors.forename: Asaf
authors.initials: A
authors.lastname: Gave
authors.affiliation: Division of Surgical-Critical Care, Department of Surgery, Icahn School of Medicine at Mount Sinai Beth Israel, First Avenue and 16th Street, New York, NY 10003, USA.
authors.forename: I Michael
authors.initials: IM
authors.lastname: Leitman
authors.affiliation: Division of Surgical-Critical Care, Department of Surgery, Icahn School of Medicine at Mount Sinai Beth Israel, First Avenue and 16th Street, New York, NY 10003, USA.
authors.forename: Simon D
authors.initials: SD
authors.lastname: Eiref
keywords: BGA, blood gas analyzer; CL, core lab; Capillary lactate; Finger-stick; ICU, intensive care unit; POC, point-of-care; Point-of-care; Shock