Evaluation of Blood Lactate Concentrations as a Marker for Resuscitation and Prognosis in Patients with Major Burns

Abstract

Background Severe burns require appropriate fluid management in the acute phase. A massive volume of intravenous fluid is usually required to ensure adequate end-organ perfusion. Lactate is a product of anaerobic metabolism. A high level of lactate in tissue is direct indication of tissue hypoxia. The correlation between serum lactate and clinical outcome has been well accepted in hemorrhagic and septic shock. However, studies on its use in predicting mortality and morbidity of major burn patients in particular is sparse. Early prediction of outcome in patients with major burn is very likely to aid suitable modification of management strategies. Objective To assess the role of serum lactate measurement as the predictor burn patient's outcome (survivors and non-survivors). Patients and Methods 30 patients with major burn (more than 20% of TBSA) were included. This includes operated/ non-operated patients. Of the 30 patients, 20 were males and 10 were females. All adult burned patients admitted within the first 24h post burn were included in the study. Patients admitted after 24h from the thermal injury, or those who were discharged or died 48h after admission were excluded. Results Serial blood lactate measures were better as a prognostic tool than isolated measure. Reduction or normalization of lactate levels 24 hours after admission was significantly associated with a higher probability of survival. This study confirms the prognostic value of serum lactate for mortality in patients with major burns as serial blood lactate measurements predict mortality in these patients. Conclusion Although many studies reiterate the importance of blood lactate and lactate clearance in predicting mortality in burn patients, the role of these markers in therapy titration is ambiguous. Overzealous fluid resuscitation can cause fluid overload and acute respiratory distress syndrome. little regional data are available to establish the importance of blood lactate. We have demonstrated the association of blood lactate in the first 36 hours of the burn injury with mortality. Further large multicenter prospective studies are required.