|Non invasive ventilation (NIV)
|Intubation and Mechanical Ventilation
|Critical illness neuromuscular weaknesss
- Lactate is produced as a by-product of anaerobic respiration. A raised lactate can be caused by any process which causes tissue to use anaerobic respiration. It is a good indicator of poor tissue perfusion.
- Lactate levels are commonly evaluated in acutely ill patients. Although most commonly used in the context of evaluating shock, lactate can be elevated for many reasons.
- Tissue hypoperfusion is probably the most common cause of elevation, many other etiologies or contributing factors exist.
- Elevated lactate is not clearly and universally defined but most studies use cut-offs between 2.0 and 2.5 mmol/L whereas lactate has been defined as a lactate level > 4mmol/L in a number of studies
- Post-arrest patients with an initial lactate <5 mmol/L had a mortality of 39% whereas mortality rose to 92% with an initial lactate > 10mmol/L
- Elevated lactate can be caused by a number of conditions including shock, sepsis, cardiac arrest, trauma, seizure, ischemia, diabetic ketoacidosis, thiamine deficiency, malignancy, liver dysfunction, genetic disorders, toxins, and medications
Causes of raised lactate
- Shock : Distributive, Cardiogenic, Hypovolaemic
Obstructive, Post-cardiac arrest
- Pharmacological agents: Linezolid, Nucleoside reverse transcriptase inhibitors,
Metformin, Epinephrine, Propofol, Acetaminophen, Beta2 agonists, Theophylline
- Regional tissue ischaemia: Mesenteric ischaemia, Limb ischaemia, Burns
Anaerobic muscle activity
Necrotizing soft tissue infections
Excessive work of breathing