From the Research
Lactate levels should be checked every 2 hours in critically ill patients with suspected or confirmed lactic acidosis, with more frequent monitoring (every 1 hour) during acute resuscitation phases, as recommended by the most recent and highest quality study 1. This monitoring schedule is crucial in evaluating tissue perfusion and oxygen delivery, as elevated lactate indicates anaerobic metabolism due to inadequate oxygen at the cellular level. The trend in lactate clearance is often more valuable than single measurements in guiding clinical decisions, and a decrease in lactate levels generally suggests improving tissue perfusion and effective treatment, while persistently elevated or rising levels may indicate ongoing shock requiring treatment escalation 2, 3, 4, 5. Key points to consider when monitoring lactate levels include:
- Initial measurement should occur as part of the initial assessment, followed by serial measurements to track response to treatment.
- For patients on vasopressors or with sepsis, checking lactate within the first hour and then every 2 hours until stabilization is recommended.
- Once the patient shows clinical improvement and lactate levels are trending downward, frequency can be reduced to every 4-6 hours, then daily.
- Lactate clearance is associated with improved outcome across several cohorts of critically ill patients, and targeting lactate clearance as part of a quantitative resuscitation strategy may be as effective as targeting central venous oxygen saturation 2, 5. It is essential to note that lactate monitoring should be integrated into routine clinical practice to optimize patient care and improve clinical outcomes in intensive care settings, as highlighted in the most recent review on the topic 1.