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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

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My Heart is Racing! Select Cardiac Arrhythmias and Practice Updates

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lunes, 17 de junio de 2013

Acido láctico y Sepsis: debate; paradigna en decadencia?

Lactate clearence as a target of therapy in sepsis: a flawed paradigm
Marik PE, Bellomo R, Demla V. Lactate clearance as a target of therapy in sepsis: A flawed paradigm. OA Critical Care 2013 Mar 01;1(1):3

"An increased blood lactate level is widely believed to be a marker of inadequate oxygen delivery and anaerobic metabolism. Furthermore, the rate of decline in lactate concentration (lactate clearance) has been recommended as an end-point of early goal-directed therapy in critical ill patients with sepsis. We provide compelling data that an elevated lactate concentration is a consequence of increased aerobic glycolysis as part of the stress response and that titrating therapy to the rate of decline in lactate concentration is a potentially harmful endeavour. Furthermore, an increased lactate concentration may be an important adaptive survival response during critical illness.
Conclusion
An elevated lactate concentration in patients with sepsis is a marker of disease severity and not an indication of anaerobic metabolism. Increasing oxygen delivery to treat a non-existent oxygen debt may be a harmful undertaking. ‘Lactate clearance‚ should not be used as the end-point of resuscitation in patients with sepsis."

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Broome Docs
Posted on JUNE 13, 2013 at 10:25 PM by CASEYE PARKER