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Abstract

Background and aims: Though there is an association between elevated lactate and poorer outcomes in acutely unwell children, its utility in clinical practice has not been clearly defined. Aims: We present the evidence for the use of lactate as a diagnostic and therapeutic marker in Intensive Care. Methods: Literature search using PubMed database. Results: The physiology of lactate is complex: elevated levels represent a metabolic imbalance which may be global and/or regional. A raised blood lactate – particularly persistently elevated – may be associated with poorer outcomes in an acutely unwell children or neonates, but there are several exceptions and no threshold level has been determined. There remains insufficient evidence to support the use of lactate as a therapeutic endpoint in acutely unwell children. In neonates with suspected necrotising enterocolitis, higher lactate levels correlate with poorer outcomes, but there is no evidence to support its use as a diagnostic tool. Elevated lactate in children with acute severe asthma treated with beta-2 agonists is most likely due to the treatment rather than the disease. Conclusions: Lactate physiology is complex: blood levels represent a balance between production, consumption and transport. Elevated blood lactate is associated with increased morbidity and mortality in acutely unwell children, however, many studies are of poor quality, there is significant heterogeneity, and no consensus threshold level for hyperlactataemia. Future research should explore the role of lactate as a metabolic fuel in different tissues and organs, validate its predictive value in large, prospective trials, and investigate its role as a therapeutic target.