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Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: The riddle of hyperlactatemia. | Available online http ccforum.eom content 13 4 176 Commentary The riddle of hyperlactatemia Guillermo Gutierrez and Jeffrey D Williams The George Washington University Medical Faculty Associates 2150 Pennsylvania Avenue N.W. Suite 5-427 Washington DC 20037 USA Corresponding author Guillermo Gutierrez ggutierrez@mfa.gwu.edu Published 12 August 2009 This article is online at http ccforum.com content 13 4 176 2009 BioMed Central Ltd Critical Care 2009 13 176 doi 10.1186 cc7982 See related research by Khosravani et al. http ccforum.com content 13 3 R90 Abstract A recent observational study in a large cohort of critically ill patients confirms the association between hyperlactatemia and mortality. The mechanisms regulating the rates of lactate production and clearance in critical illness remain poorly understood. During exercise hyperlactatemia clearly results from an imbalance between oxygen delivery and energy requirements. In critically ill patients the genesis of hyperlactatemia is significantly more complex. Possible mechanisms include regional hypoperfusion an inflammation-induced upregulation of the glycolitic flux alterations in lactate-clearing mechanisms and increases in the work of breathing. Understanding how these complex processes interact to produce elevations in lactate continues to be an important area of research. The lack of a reliable indicator to assess cellular hypoxia and monitor the effectiveness of therapeutic interventions remains a major challenge in critical care medicine. In a study published in the previous issue of Critical Care Khosravani and colleagues 1 further illustrated the independent association between mortality and blood lactate levels. They noted an independent association between mortality and blood lactate levels of above 2.0 mmol L. Their study is important for several reasons. First the authors cast a wide net by including all adult intensive care unit admissions n 13 932 occurring during a 3-year period in a well-defined .
