Venous Blood Lactate Concentration Research Articles

Effect of transfusion on the venous blood lactate level in very low-birthweight infants

In recent years the blood lactate level can be easily and quickly measured with a small amount of blood, and the availability of an arterial blood lactate level has been reported as an indicator of oxygen deficit in adults. To determine whether venous blood lactate level can serve as such a marker for determining the indications for transfusion, blood lactate and hemoglobin level were monitored before and after transfusion. The study subjects consisted of 12 very low-birthweight infants admitted to the neonatal intensive care unit and who had transfusion between June 2005 and June 2007. The data on the blood lactate and hemoglobin were collected retrospectively by referring to the clinical records. A total of 18 transfusions was performed. There was no significant relationship between venous blood lactate and hemoglobin concentration before transfusion. The subjects were classified into two groups according to the lactate level before transfusion: > or =3.3 mmol/L and <3.3 mmol/L. In the high-lactate group the lactate decreased significantly after transfusion (P < 0.01) and it continued to decrease thereafter. In the low-lactate group, however, the lactate remained unchanged. Venous blood lactate measurements may offer some additional information regarding the optimal time for performing a transfusion. To the authors' knowledge this is the first report to study the changes in lactate levels using venous blood sampling in red blood cell transfusion in very low-birthweight infants.

Lactate concentration in umbilical cord blood is gestational age‐dependent: a population‐based study of 17 867 newborns

To study the influence of gestational age on lactate concentration in arterial and venous umbilical cord blood at birth and to define gestational age-specific reference values for lactate in vigorous newborns. Population-based comparative. University hospitals. Vigorous newborns with validated umbilical cord blood samples. From 2000 to 2004, routine cord blood gases, lactate and obstetric data from two university hospitals were available for 17 867 newborns from gestational week 24 to 43. After validation of blood samples and inclusion only of singleton pregnancies aimed for vaginal delivery, 10 700 women remained. Among those, reference values were defined in 10 169 vigorous newborns, that is in newborns with a 5-minute Apgar score corresponding to the gestational age-specific median value minus 1 point score, or better. Cord lactate concentration relative to gestational age. The arterial and venous lactate concentrations increased monotonously with gestational age from 34 weeks. Considerable differences were found between mean and median values, but after logarithmic transformation the log-lactate values were normally distributed. Simple linear regression analysis showed a significant association between the log-lactate values and gestational age (P < 10(-6), R(2)= 0.024). Reference curves were constructed after anti-logarithmic transformation. Both the gestational age and the time of the second stage of labour influenced, independently of each other, the lactate concentrations. Lactate concentrations in arterial and venous umbilical cord blood are increasing significantly with advancing gestational age.

Delayed umbilical cord clamping at birth has effects on arterial and venous blood gases and lactate concentrations

To estimate the influence of delayed umbilical cord clamping at birth on arterial and venous umbilical cord blood gases, bicarbonate (HCO3-), base excess (BE) and lactate in vigorous newborns. University hospital. Prospective observational. Vaginally delivered term newborns. Umbilical cord arterial and venous blood was sampled repeatedly every 45 seconds (T(0)= time zero; T(45)= 45 seconds, T(90)= 90 seconds) until the cord pulsations spontaneously ceased in 66 vigorous singletons with cephalic vaginal delivery at 36-42 weeks. Longitudinal comparisons were performed with the Wilcoxon signed-ranks matched pairs test. Mixed effect models were used to describe the shape of the regression curves. Longitudinal changes of umbilical cord blood gases and lactate. In arterial cord blood, there were significant decreases of pH (7.24-7.21), HCO3- (18.9-18.1 mmol/l) and BE (-4.85 to -6.14 mmol/l), and significant increases of PaCO(2) (7.64-8.07 kPa), PO(2) (2.30-2.74 kPa) and lactate (5.3-5.9 mmol/l) from T(0) to T(90), with the most pronounced changes at T(0)-T(45). Similar changes occurred in venous blood pH (7.32-7.31), HCO3- (19.54-19.33 mmol/l), BE (-4.93 to -5.19 mmol/l), PaCO(2) (5.69-5.81 kPa) and lactate (5.0-5.3 mmol/l), although the changes were smaller and most pronounced at T(45)-T(90). No significant changes were observed in venous PO(2). Persistent cord pulsations and delayed cord clamping at birth result in significantly different measured values of cord blood acid-base parameters.

Comparison of canine capillary and jugular venous blood lactate concentrations determined by use of an enzymatic-amperometric bedside system

Comparison of canine capillary and jugular venous blood lactate concentrations determined by use of an enzymatic-amperometric bedside system

Comparison of canine capillary and jugular venous blood lactate concentrations determined by use of an enzymatic-amperometric bedside system

To evaluate the analytical agreement between blood lactate concentrations determined by use of an enzymatic-amperometric bedside system in capillary blood samples from the pinna and in jugular venous blood samples from dogs. 53 dogs. For each dog, venous and capillary blood samples were obtained from a jugular vein and from the ear pinna (by use of a lancing device), respectively, following a randomized sequence of collection. Lactate concentrations in both types of samples were analyzed by use of an enzymatic-amperometric bedside system intended for lactate detection in capillary blood samples from humans that was previously validated in dogs. The Passing-Bablock regression analysis was used to compare venous and capillary blood lactate concentrations; the level of agreement was calculated by use of the Bland-Altman method. Jugular venous blood samples were collected without difficulty from all 53 dogs. A capillary blood sample was obtained from only 47 dogs. The correlation coefficient between lactate concentrations measured in venous and capillary blood samples was 0.58 (slope, 2.0 [95% confidence interval, 1.5 to 3.0]; intercept, -1.2 [95% confidence interval, -3.1 to 0.4]). The mean difference between methods was 0.72 mmol/L (95% confidence interval, 0.38 to 1.06) with limits of agreement of -1.55 to 2.99 mmol/L. Because of the lack of agreement between lactate concentrations determined in capillary and jugular venous blood samples, measurement of capillary blood lactate concentration in dogs performed with the technique used in the study does not appear to be a reliable alternative to jugular venous blood measurements.

Effect of Maleimide-Polyethylene Glycol Hemoglobin (MP4) on Hemodynamics and Acid-Base Status After Uncontrolled Hemorrhage in Anesthetized Swine: Comparison With Crystalloid and Blood

Maleimide-polyethylene glycol hemoglobin, 4.3 g/dL (MP4), is a hemoglobin-based oxygen carrier consisting of native human hemoglobin modified with maleimide polyethylene glycol. This study evaluated resuscitation with MP4 after uncontrolled hemorrhage in anesthetized swine, and compared the effects of MP4 alone with those of standard-of-care crystalloid or crystalloid + blood. Pigs were anesthetized with isoflurane and hemorrhaged 250 mL by controlled withdrawal, which was followed by a 5-mm tear in the abdominal aorta. Three groups of pigs (n = 7 each) were randomized after aortic tear to receive 500 mL of MP4, unlimited Ringer's acetate (RA), or 2 L of RA + 250 mL of autologous blood. Measurements included arterial and pulmonary artery pressures, central venous and pulmonary capillary wedge pressures, cardiac output, renal blood flow, urine output, arterial and venous blood gases, lactate concentration, and hemoglobin. Animals were monitored for 150 minutes after hemorrhage. Average body weight (22-24 kg) and hemorrhage volume (28-34 mL/kg) were similar in the three groups. The nadir of mean arterial pressure (23-25 mm Hg) and base excess (-3 to -4 mEq/L) after hemorrhage were similar in all groups, indicating equivalent shock in the three groups. Two hours after administration of MP4, arterial pressure and base excess were significantly improved compared with those of animals administered RA or RA + blood, despite a significantly lower volume of infused fluids (MP4 = 36 +/- 2 mL/kg; RA = 224 +/- 28 mL/kg; RA + blood = 110 +/- 10 mL/kg), and a significantly lower total hemoglobin than achieved with RA + blood. Arterial pressure did not rise above baseline values, cardiac output was not diminished, and systemic vascular resistance was unchanged after administration of MP4, indicating the lack of cardiac effects or peripheral vasoconstriction. These data demonstrate that resuscitation with a small volume of MP4 induces recovery from hemorrhage without vasoconstriction. Overall, the effects of MP4 alone on hemodynamic and acid-base indices appear to be of greater benefit than those observed with a large volume of RA alone or RA + blood.

Changes in central venous pressure and blood lactate concentration in response to acute blood loss in horses

To evaluate selected hemodynamic, blood gas, and biochemical responses to mild to moderate acute blood loss in standing, awake horses. Prospective study. 7 healthy mares. Each horse was restrained in standing stocks, and its head was maintained in a neutral position; sedatives and tranquilizers were not administered. During a 1-hour period, blood was collected into collection bags by use of a suction pump. The rate of blood collection was approximately 16 mL/kg/h (7.3 mL/lb/h). Thirty minutes after blood collection, the blood was readministered at the same rate. Central venous pressure (CVP), central venous blood gas, blood lactate concentration, and heart rate were measured at baseline (after placement of catheters), after removal of blood, and after readministration of blood. In response to blood loss, CVP decreased and blood lactate concentration increased significantly, compared with baseline values; heart rate and results of central venous blood gas analysis did not change significantly. After readministration of blood, CVP returned to baseline value and blood lactate concentration approached baseline value. Changes in CVP and blood lactate concentration appear to be early indicators of hypovolemia in horses, which may represent acute blood loss in trauma patients; these variables should be monitored to assess the potential need for blood transfusions. These variables can be used to monitor responses of horses to blood transfusions when whole blood is administered as the replacement fluid.

Effect of Hypoxia on the Kinetics of Peripheral Muscle Oxygenation during Prolonged Exercise

Near-infrared spectroscopy (NIRS) is a noninvasive method of measuring muscle oxygenation. We have examined relationships between muscle oxygenation and blood lactate concentration, substrate utilization, femoral artery blood flow, and systemic oxygen intake during prolonged exercise. However, we have not examined muscle oxygenation trends during prolonged exercise at different oxygen levels. PURPOSE: To clarify the effect of hypoxia (FiO2=0.16) on the local muscle oxygenation trends during prolonged cycle exercise at ventilatory threshold (VT) level. METHODS: Seven healthy males completed an orientation trial and a maximal exercise test, followed by two 30-min submaximal exercise bouts. During each exercise test, expiratory gas analysis was performed using an expiratory gas analyzer, and the muscle oxygenation trends of vastus lateralis muscle were determined by NIRS. After exercises, calibration was performed by cuff occlusion at 260 mmHg for 10 min. Cardiorespiratory parameters, forearm venous blood lactate concentration and epinephrine levels were measured at rest and during exercise. RESULTS: Arterial O2 saturation levels at rest and during exercise in the hypoxic condition were significantly lower than those in normoxia condition (p<0.05). VO2, HR and epinephrine levels during exercise in the hypoxic condition were significantly higher than those in normoxia condition (p<0.05). Muscle oxygenation decreased immediately after the onset of exercise and gradually increased, but it did not reach the resting level. This pattern of muscle oxygenation was similar for two gas conditions. However, the rate of decrease in muscle oxygenation was enhanced by reduced arterial O2 saturation. On the other hand, after the initial drop, the rate of increase in muscle oxygenation during exercise did not change for two gas conditions. These results indicate that the rate of decrease in muscle oxygenation is sensitive to oxygen delivery. CONCLUSIONS: The significant decrease in muscle oxygenation induced by hypoxia during prolonged exercise at VT level was due to a greater release of oxygen by oxyhemoglobin at the capillaries via Bohr effect.

Maximal voluntary hyperpnoea increases blood lactate concentration during exercise

Ventilatory work during heavy endurance exercise has not been thought to influence systemic lactate concentration. We evaluated the effect of maximal isocapnic volitional hyperpnoea upon arterialised venous blood lactate concentration ([lac-]B) during leg cycling exercise at maximum lactate steady state (MLSS). Seven healthy males performed a lactate minimum test to estimate MLSS, which was then resolved using separate 30 min constant power tests (MLSS=207+/-8 W, mean +/- SEM). Thereafter, a 30 min control trial at MLSS was performed. In a further experimental trial, the control trial was mimicked except that from 20 to 28 min maximal isocapnic volitional hyperpnoea was superimposed on exercise. Over 20-28 min minute ventilation, oxygen uptake, and heart rate during the control and experimental trials were 87.3+/-2.4 and 168.3+/-7.0 l min(-1) (P<0.01), the latter being comparable to that achieved in the maximal phase of the lactate minimum test (171.9+/-6.8 l min(-1)), 3.46+/-0.20 and 3.83 +/- 0.20 l min(-1) (P<0.01), and 158.5+/-2.7 and 166.8+/-2.7 beats min(-1) (P<0.05), respectively. From 20 to 30 min of the experimental trial [lac-]B increased from 3.7+/-0.2 to 4.7+/-0.3 mmol l(-1) (P<0.05). The partial pressure of carbon dioxide in arterialised venous blood increased approximately 3 mmHg during volitional hyperpnoea, which may have attenuated the [lac-]B increase. These results show that, during heavy exercise, respiratory muscle work may affect [lac-]B. We speculate that the changes observed were related to the altered lactate turnover in respiratory muscles, locomotor muscles, or both.

Liver function and lactate metabolism in the ill surgical patient.

Liver function and lactate metabolism were investigated in non-shocked, severely ill surgical patients. Fasting venous blood lactate concentration was increased and plasma liver function tests were abnormal in ill patients compared with controls. Ill patients were glucose-intolerant and blood lactate changes following intravenous glucose infusion were similar in both ill and control patients. Blood lactate half-life was increased in ill patients following a sodium L-lactate infusion, suggesting that the increased fasting lactate concentration may have been due to decreased hepatic removal rather than to increased peripheral production of lactate.

Serial plasma lactate concentrations in 68 puppies aged 4 to 80 days

AbstractObjective: To determine a reference range for venous blood lactate concentrations in healthy neonatal dogs.Design: A prospective cohort study.Setting: All work was conducted at the College of Veterinary Medicine, Texas A&amp;M University.Animals: Clinically healthy dogs: 68 puppies and 30 adults.Measurements and main results: A blood sample was collected from each puppy into lithium heparin via jugular venipuncture at 4, 10, 16, 28, 70, and 80 days of age. A single venous sample was collected from each adult dog. Lactate concentration in each sample was measured immediately using an automated analyzer. Two hundred seventy‐seven blood samples were analyzed. Blood lactate concentrations of adult dogs were 1.80±0.84 mmol/L (mean±SD). Mean blood lactate concentrations of puppies were significantly higher at 4, 10, 16, and 28 days of age compared with those of adult dogs. The reference range for lactate concentration for puppies at 4 days of age was 1.07–6.59, and for the puppies from 10 to 28 days of age was 0.80–4.60.Conclusions: Assessment of perfusion can be challenging in neonates due to normal physiologic variation and small size. Measurement of lactate is rapid, minimally invasive, and has potential to be a useful marker of perfusion in neonatal dogs. However, lactate concentrations of neonatal dogs in this study were significantly higher than those of adult dogs. Reference ranges for venous lactate concentrations in adult dogs should not be used for puppies younger than 70 days of age.

Characterization of the Pharmacokinetic and Pharmacodynamic Properties of the Angiotensin‐Converting Enzyme Inhibitor, Enalapril, in Horses

The pharmacokinetics of enalapril (0.5 mg/kg IV) and the pharmacodynamics of enalapril (0.5 mg/kg PO) in 5 mares were investigated. After single IV dosing, concentrations of enalapril and enalaprilat, its active metabolite, were measured. Two weeks later, enalapril was administered by nasogastric tube. Potassium, creatinine, blood urea nitrogen (BUN), enalapril, and enalaprilat concentrations and angiotensin converting enzyme (ACE) activity were measured in serum. In addition, heart rate, blood pressure, digital venous blood gases, and lactate were measured. Two weeks later, enalapril was again administered by nasogastric tube. To mimic activation of the renin‐angiotensin‐aldosterone system, angiotensin I (0.5 μg/kg) was administered at fixed intervals, followed by blood‐pressure and heart‐rate measurement. The elimination half lives of enalapril and enalaprilat were 0.59 and 1.25 hours, respectively, after IV administration. After PO administration, enalapril and enalaprilat were not detectable in serum. There was a tendency(P= .0625) toward a decrease in ACE activity 45–120 minutes after enalapril administration, but ACE activity suppression was never &gt;16%. There was a tendency(P= .0625) toward a decrease in mean arterial pressure (MAP) 6–8 hours after enalapril administration. Serum concentrations of potassium, creatinine, and BUN and digital venous blood gases and lactate concentrations did not change. In response to angiotensin I, there was a tendency(P= .0625) toward a decrease in the MAP response 4–24 hours after enalapril administration. Single‐dose enalapril at 0.5 mg/kg PO did not demonstrate significant availability, pharmacodynamic effect, or substantial suppression of ACE activity.

Characterization of the Pharmacokinetic and Pharmacodynamic Properties of the Angiotensin-Converting Enzyme Inhibitor, Enalapril, in Horses

The pharmacokinetics of enalapril (0.5 mg/kg i.v.) and the pharmacodynamics of enalapril (0.5 mg/kg PO) in 5 mares were investigated. After single i.v. dosing, concentrations of enalapril and enalaprilat, its active metabolite, were measured. Two weeks later, enalapril was administered by nasogastric tube. Potassium, creatinine, blood urea nitrogen (BUN), enalapril, and enalaprilat concentrations and angiotensin converting enzyme (ACE) activity were measured in serum. In addition, heart rate, blood pressure, digital venous blood gases, and lactate were measured. Two weeks later, enalapril was again administered by nasogastric tube. To mimic activation of the renin-angiotensin-aldosterone system, angiotensin I (0.5 microg/kg) was administered at fixed intervals, followed by blood-pressure and heart-rate measurement. The elimination half lives of enalapril and enalaprilat were 0.59 and 1.25 hours, respectively, after i.v. administration. After PO administration, enalapril and enalaprilat were not detectable in serum. There was a tendency (P = .0625) toward a decrease in ACE activity 45-120 minutes after enalapril administration, but ACE activity suppression was never > 16%. There was a tendency (P = .0625) toward a decrease in mean arterial pressure (MAP) 6-8 hours after enalapril administration. Serum concentrations of potassium, creatinine, and BUN and digital venous blood gases and lactate concentrations did not change. In response to angiotensin I, there was a tendency (P = .0625) toward a decrease in the MAP response 4-24 hours after enalapril administration. Single-dose enalapril at 0.5 mg/kg PO did not demonstrate significant availability, pharmacodynamic effect, or substantial suppression of ACE activity.

Lactate concentrations in human skeletal muscle biopsy, microdialysate and venous blood during dynamic exercise under blood flow restriction

Lactate concentrations in human skeletal muscle biopsy, microdialysate and venous blood during dynamic exercise under blood flow restriction

This Month in ANESTHESIOLOGY

This Month in ANESTHESIOLOGY

Lactate concentrations in human skeletal muscle biopsy, microdialysate and venous blood during dynamic exercise under blood flow restriction.

The intramuscular microdialysate lactate concentration during dynamic exercise with various degrees of blood flow restriction and its relation to lactate concentration in skeletal muscle biopsy and venous blood were studied. Nine healthy males performed three one-legged knee extension exercises (Ex 1-3). Blood flow was restricted stepwise by applying supra-atmospheric pressure over the working leg. Microdialysate mean (range) lactate concentrations at the end of the exercise periods were 3.2 (0.5-6.6), 4.4 (1.1-9.8) and 7.9 (1.1-11.6) mmol.l(-1)during unrestricted, moderately restricted and severely restricted blood flow respectively. There was a significant correlation between microdialysate and venous lactate concentrations at the end of all three exercise periods. Microdialysate lactate concentration correlated significantly to skeletal muscle biopsy lactate concentration at the end of Ex 1. In conclusion, microdialysate lactate concentration in the working muscle increased step-wise with increasing blood flow restriction. It showed a better correlation to venous than to muscle biopsy lactate, which is possibly partly explained by the characteristics of diffusion between body compartments and differences in time resolution between the methods used.

Venous blood lactate increase after vertical jumping in volleyball athletes.

The aim of this study was to test the hypothesis that venous blood lactate concentrations ([La-]) would vary from the beginning of brief exercise. Maximal vertical jumping was used as a model of brief intense exercise. Eleven healthy male volleyball players, aged [mean (SE)] 18.5 (0.7) years, performed three exercise tests with different protocols, each separated by quiet seated recovery periods of 45 min. After the first test, consisting of a single maximal jump [lasting approximately equals 0.6 s for the pushing phase, and in which the subjects jumped 64 (2.2) cm], forearm venous [La-] increased significantly with respect to rest at 1 min (t1), 3 min (t3), and 5 min (t5) of recovery. The second test, comprising six maximal jumps, each separated by 20-s recovery periods, resulted in an unchanged [La-] with respect to the baseline value. After the third test [i.e., six consecutive maximal jumps that lasted a total of 7.36 (0.33) s], [La-] increased significantly at t3 and t5 with respect to the pre-test value (F= 10.3, P < 0.001). We conclude that a significant venous [La-] increase occurs after vertical jumping. This result may be explained by the activation of lactic anaerobic metabolism at the very onset of exercise, which participates in energy production and/or in the resynthesis of the phosphocreatine that was used during such brief exercise.

The effects of hyperoxia on performance during simulated firefighting work

This study evaluated the effects of hyperoxia (inspired oxygen fraction=40%) on performance during a simulated firefighting work circuit (SFWC) consisting of five events. On separate days, 17 subjects completed at least three orientation trials followed by two experimental trials while breathing either normoxic (NOX) and hyperoxic (HOX) gas mixtures that were randomly assigned in double-blind, cross-over design. Previously, ventilatory threshold (Tvent) and VO2max had been determined during graded exercise (GXT) on a cycle ergometer. Lactate concentration in venous blood was assessed at exactly 5 min after both the experimental trials and after the GXT. Total time to complete the SFWC was decreased by 4% (p< 0.05) with HOX. No differences were observed in individual event times early in the circuit, however HOX resulted in a 12% improvement (p< 0.05) on the final event. A significantly decreased rating of perceived exertion (RPE) was also recorded immediately prior to the final event. No differences were observed in mean heart rate or post-exercise blood lactate when comparing NOX to HOX. Heart rates during the SFWC (both conditions) were higher than HR at Tvent, but lower than HR at VO2max (p< 0.05). Post-SFWC lactate values were higher (p< 0.05) than post-VO2max. These results demonstrate that hyperoxia provided a small but significant increase in performance during short duration, high intensity simulated firefighting work.

Effects of ethanol on brain lactate in experimental traumatic brain injury with hemorrhagic shock

Objective: Previous studies of traumatic brain injury (TBI) and hemorrhagic shock (HS) models, have shown cardiorespiratory depression in ethanol-treated animals. This study investigated the effects of ethanol (ET) on brain lactate concentrations and acidosis in a TBI/HS model. Methods: Anesthetized swine were instrumented and subjected to injury (INJ) consisting of fluid percussion TBI of 3 atm with concurrent 30 ml/kg graded hemorrhage over 30 min. Three groups were studied: Sham, INJ and INJ/ET. ET was given preinjury as a 2-g/kg i.v. bolus over 30 min, and an infusion of 0.4 g kg −1 h −1. Cardiorespiratory and cerebral physiologic data were monitored continuously for 150 min postinjury. Cerebral and renal blood flow was measured with colored microspheres. Brains were frozen in situ with liquid nitrogen. Lactate was measured with an enzymatic method. Results: ET levels at injury were 219±24 mg/dl. The INJ/ET group had increased mortality, impaired ventilation, and reduced renal blood flow. Brain (cortical) lactate levels were significantly higher and cerebral venous lactate concentrations were increased in the INJ/ET group during the postinjury period. Cerebral venous glucose was significantly higher in the INJ/ET group, and cerebral venous pH was significantly lower. Conclusion: In this TBI/HS model, ethanol-induced increases in lactate concentrations in brain tissue and cerebral venous blood are associated with respiratory depression and reduced organ blood flow.

Gastrointestinal Monitoring Using Measurement of Intramucosal PCO2

Gastrointestinal Monitoring Using Measurement of Intramucosal PCO2