Background: Using blood lactate monitoring for risk assessment in the critically ill patient remains controversial.\r\nSome of the discrepancy is due to uncertainty regarding the appropriate reference interval, and whether to\r\nperform a single lactate measurement as a screening method at admission to the hospital, or serial lactate\r\nmeasurements. Furthermore there is no consensus whether the sample should be drawn from arterial, peripheral\r\nvenous, or capillary blood. The aim of this review was:\r\n1) To examine whether blood lactate levels are predictive for in-hospital mortality in patients in the acute setting, i.\r\ne. patients assessed pre-hospitally, in the trauma centre, emergency department, or intensive care unit.\r\n2) To examine the agreement between arterial, peripheral venous, and capillary blood lactate levels in patients in\r\nthe acute setting.\r\nMethods: We performed a systematic search using PubMed, Cochrane Central Register of Controlled Trials,\r\nCochrane Database of Systematic Reviews, and CINAHL up to April 2011. 66 articles were considered potentially\r\nrelevant and evaluated in full text, of these ultimately 33 articles were selected.\r\nResults and Conclusion: The literature reviewed supported blood lactate monitoring as being useful for risk\r\nassessment in patients admitted acutely to hospital, and especially the trend, achieved by serial lactate sampling, is\r\nvaluable in predicting in-hospital mortality. All patients with a lactate at admission above 2.5 mM should be closely\r\nmonitored for signs of deterioration, but patients with even lower lactate levels should be considered for serial\r\nlactate monitoring. The correlation between lactate levels in arterial and venous blood was found to be acceptable,\r\nand venous sampling should therefore be encouraged, as the risk and inconvenience for this procedure is minimal\r\nfor the patient. The relevance of lactate guided therapy has to be supported by more studies.
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