The value of blood lactate kinetics in critically ill patients: a systematic review.
The value of blood lactate kinetics in critically ill patients: a systematic review.
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DOI：
10.1186/s13054-016-1403-5
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发表时间：
2016-08-13
期刊：
影响因子：
--
通讯作者：
Taccone FS
中科院分区：
文献类型：
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作者：
Vincent JL;Quintairos E Silva A;Couto L Jr;Taccone FS
血乳酸水平的时间过程可能有助于评估患者对治疗的反应。虽然已发表的研究主要集中在脓毒症患者，但许多其他研究报告了不同急性病患者组的连续血乳酸水平。我们对PubMed、Science Direct和Embase进行了系统性检索，检索时间截止至2016年2月底，还包括相关出版物的参考文献列表。我们选择了所有评价系列血乳酸浓度预测结果能力的观察性和干预性研究。没有基于语言的限制。我们排除了儿科人群的研究、实验性研究以及未报告乳酸值或全因死亡率变化的研究。我们根据纳入的患者类型将研究分开。我们收集了患者数量、乳酸盐测量时间、入选所需的最低乳酸盐水平（如果存在）以及预测使用的建议时间间隔等数据。共有96项研究符合我们的标准：14项在普通ICU人群中，5项在普通外科ICU人群中，5项在心脏手术后患者中，14项在创伤患者中，39项在脓毒症患者中，4项在心源性休克患者中，8项在心脏骤停后患者中，3项在呼吸衰竭患者中，4项在其他条件下。在所有亚组患者中，乳酸水平随时间降低始终与死亡率降低相关。大多数研究报告了6、12或24小时内的变化，使用较短时间间隔的研究较少。乳酸动力学在脓毒症患者和其他类型患者中没有明显差异。一些研究表明，治疗可以通过这些测量来指导。在整个临床研究中，观察到与血乳酸浓度降低相关的更好结局是一致的，并且不仅限于败血症患者。在所有组中，变化相对缓慢，因此在大多数急性条件下，每1-2小时测量一次乳酸盐可能就足够了。无论初始值如何，乳酸动力学值似乎都是有效的。
The time course of blood lactate levels could be helpful to assess a patient’s response to therapy. Although the focus of published studies has been largely on septic patients, many other studies have reported serial blood lactate levels in different groups of acutely ill patients. We performed a systematic search of PubMed, Science Direct, and Embase until the end of February 2016 plus reference lists of relevant publications. We selected all observational and interventional studies that evaluated the capacity of serial blood lactate concentrations to predict outcome. There was no restriction based on language. We excluded studies in pediatric populations, experimental studies, and studies that did not report changes in lactate values or all-cause mortality rates. We separated studies according to the type of patients included. We collected data on the number of patients, timing of lactate measurements, minimum lactate level needed for inclusion if present, and suggested time interval for predictive use. A total of 96 studies met our criteria: 14 in general ICU populations, five in general surgical ICU populations, five in patients post cardiac surgery, 14 in trauma patients, 39 in patients with sepsis, four in patients with cardiogenic shock, eight in patients after cardiac arrest, three in patients with respiratory failure, and four in other conditions. A decrease in lactate levels over time was consistently associated with lower mortality rates in all subgroups of patients. Most studies reported changes over 6, 12 or 24 hrs, fewer used shorter time intervals. Lactate kinetics did not appear very different in patients with sepsis and other types of patients. A few studies suggested that therapy could be guided by these measurements. The observation of a better outcome associated with decreasing blood lactate concentrations was consistent throughout the clinical studies, and was not limited to septic patients. In all groups, the changes are relatively slow, so that lactate measurements every 1–2 hrs are probably sufficient in most acute conditions. The value of lactate kinetics appears to be valid regardless of the initial value.