Jansen Tim C, van Bommel Jasper, Bakker Jan
Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, Netherlands.
Crit Care Med. 2009 Oct;37(10):2827-39. doi: 10.1097/CCM.0b013e3181a98899.
To decide whether the use of blood lactate monitoring in critical care practice is appropriate. We performed a systematic health technology assessment as blood lactate monitoring has been implemented widely but its clinical value in critically ill patients has never been evaluated properly.
PubMed, other databases, and citation review.
We searched for lactate combined with critically ill patients as the target patient population. Two reviewers independently selected studies based on relevance for the following questions: Does lactate measurement: 1) perform well in a laboratory setting? 2) provide information in a number of clinical situations? 3) relate to metabolic acidosis? 4) increase workers' confidence? 5) alter therapeutic decisions? 6) result in benefit to patients? 7) result in similar benefits in your own setting? 8) result in benefits which are worth the extra costs?
We concluded that blood lactate measurement in critically ill patients: 1) is accurate in terms of measurement technique but adequate understanding of the (an)aerobic etiology is required for its correct interpretation; 2) provides not only diagnostic but also important prognostic information; 3) should be measured directly instead of estimated from other acid-base variables; 4) has an unknown effect on healthcare workers' confidence; 5) can alter therapeutic decisions; 6) could potentially improve patient outcome when combined with a treatment algorithm to optimize oxygen delivery, but this has only been shown indirectly; 7) is likely to have similar benefits in critical care settings worldwide; and 8) has an unknown cost-effectiveness.
The use of blood lactate monitoring has a place in risk-stratification in critically ill patients, but it is unknown whether the routine use of lactate as a resuscitation end point improves outcome. This warrants randomized controlled studies on the efficacy of lactate-directed therapy.
确定在重症监护实践中使用血乳酸监测是否恰当。由于血乳酸监测已被广泛应用，但其在重症患者中的临床价值从未得到恰当评估，因此我们进行了一项系统的卫生技术评估。
PubMed、其他数据库及文献综述。
我们以乳酸与重症患者相结合作为目标患者群体进行检索。两名评审员根据与以下问题的相关性独立选择研究：乳酸测量是否：1）在实验室环境中表现良好？2）在多种临床情况下提供信息？3）与代谢性酸中毒相关？4）增强工作人员的信心？5）改变治疗决策？6）给患者带来益处？7）在你自己的环境中产生类似的益处？8）产生的益处是否值得额外的成本？
我们得出结论，重症患者的血乳酸测量：1）在测量技术方面是准确的，但正确解读需要充分理解（非）有氧病因；2）不仅提供诊断信息，还提供重要的预后信息；3）应直接测量，而不是从其他酸碱变量估算；4）对医护人员信心的影响未知；5）可改变治疗决策；6）与优化氧输送的治疗算法相结合时可能改善患者预后，但这仅间接得到证明；7）在全球重症监护环境中可能产生类似的益处；8）成本效益未知。
血乳酸监测在重症患者的风险分层中具有一定作用，但乳酸作为复苏终点的常规使用是否能改善预后尚不清楚。这需要对乳酸导向治疗的疗效进行随机对照研究。
