Early lactate-guided therapy in intensive care unit patients: A multicenter, open-label, randomized controlled trial
Abstract
RATIONALE: It is unknown whether lactate monitoring aimed to decrease levels during initial treatment in critically ill patients improves outcome. OBJECTIVES: To assess the effect of lactate monitoring and resuscitation directed at decreasing lactate levels in intensive care unit (ICU) patients admitted with a lactate level of greater than or equal to 3.0 mEq/L. METHODS: Patients were randomly allocated to two groups. In the lactate group, treatment was guided by lactate levels with the objective to decrease lactate by 20% or more per 2 hours for the initial 8 hours of ICU stay. In the control group, the treatment team had no knowledge of lactate levels (except for the admission value) during this period. The primary outcome measure was hospital mortality. MEASUREMENTS AND MAIN RESULTS: The lactate group received more fluids and vasodilators. However, there were no significant differences in lactate levels between the groups. In the intention-to-treat population (348 patients), hospital mortality in the control group was 43.5% (77/177) compared with 33.9% (58/171) in the lactate group (P = 0.067). When adjusted for predefined risk factors, hospital mortality was lower in the lactate group (hazard ratio, 0.61; 95% confidence interval, 0.43-0.87; P = 0.006). In the lactate group, Sequential Organ Failure Assessment scores were lower between 9 and 72 hours, inotropes could be stopped earlier, and patients could be weaned from mechanical ventilation and discharged from the ICU earlier. CONCLUSIONS: In patients with hyperlactatemia on ICU admission, lactate-guided therapy significantly reduced hospital mortality when adjusting for predefined risk factors. As this was consistent with important secondary endpoints, this study suggests that initial lactate monitoring has clinical benefit. Clinical trial registered with www.clinicaltrials.gov (NCT00270673).
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Strategies aimed at reducing lactate levels have been linked to improved clinical outcomes, reduced organ dysfunction and lower mortality rates in various shock states.
“Strategies aimed at reducing lactate levels have been linked to improved clinical outcomes, reduced organ dysfunction and lower mortality rates in various shock states [35].”
From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [35]
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- Authors
- Jansen, T. C., van Bommel, J., Schoonderbeek, F. J., Sleeswijk Visser, S. J., van der Klooster, J. M., Lima, A. P., Willemsen, S. P., & Bakker, J.
- Affiliations
- Erasmus MC (NL)
- Department of Intensive Care, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
- Ikazia Ziekenhuis (NL)
- Department of Intensive Care, Reinier de Graaf Hospital, Delft, The Netherlands
- Department of Intensive Care, St. Franciscus Gasthuis, Rotterdam, The Netherlands
- Venue
- American Journal of Respiratory and Critical Care Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2010-09
- Volume
- 182
- Issue
- 6
- Pages
- 752-761
- ISSN
- 1073-449X (ISSN-L)
- 1535-4970
- OpenAlex
- W2111883268
- Cited by
- 894
- References
- 56
- Citations by year
- 2026: 42 · 2025: 41 · 2024: 45 · 2023: 58 · 2022: 40 · 2021: 80 · 2020: 64 · 2019: 60 · 2018: 56 · 2017: 74 · 2016: 70 · 2015: 68 · 2014: 73 · 2013: 54 · 2012: 34
- FWCI
- 27.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Respiratory and Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Keywords
- lactate monitoring, hyperlactatemia, critically ill patients, intensive care unit, in-hospital mortality, fluid resuscitation, vasodilators, inotropic agents, weaning from mechanical ventilation, SOFA score, early goal-directed therapy
- MeSH terms
- Aged, Critical Care, Female, Humans, Intensive Care Units, Length of Stay, Male, Middle Aged, Risk Factors, Time Factors, Biomarkers, Proportional Hazards Models, Critical Illness, Treatment Outcome, Hospital Mortality, Lactic Acid, Kaplan-Meier Estimate
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