Influence of mechanical ventilation on blood lactate in patients with acute respiratory failure.

OBJECTIVES

To determine whether mechanical ventilation (MV) may affect blood lactate concentration in patients with acute respiratory failure.

DESIGN

Prospective observational study with follow-up to hospital discharge.

SETTING

A 17-bed medical and coronary intensive care unit in a 650-bed general hospital.

PATIENTS

55 adult patients mechanically ventilated for acute respiratory failure between May 1996 and April 1997 were recruited.

MEASUREMENTS AND RESULTS

Arterial blood samples for determination of plasma lactate and blood gas analysis were taken just before tracheal intubation on spontaneous breathing, and 20 and 60 min after the initiation of controlled MV. Cuff systemic arterial pressure was measured before tracheal intubation and every 10 min during the first h of MV. Hyperlactatemia (arterial blood lactate > or = 2 mmol/l) was present in 21 of the 55 patients studied. After 20 min of MV, there was a decrease in blood lactate from 4.74 +/- 1.78 to 3.07 +/- 1.69 mmol/l (p < 0.01); 40 min later there was a further decrease to 2.63 +/- 1.35 mmol/l (p < 0.05). The decrease in blood lactate was also observed in those patients who after starting MV developed systemic arterial hypotension (p < 0.01). In patients with a normal lactate concentration at the entry to the study, lactate remained the same after 60 min on MV (NS).

CONCLUSIONS

Controlled MV decreases substantially the severity of hyperlactatemia in patients with acute respiratory failure, and any adverse circulatory effects of MV do not alter this beneficial outcome.