![]() ![]() The potential benefits of POC handheld devices in the clinical setting are summarised in Table 1. Lactate measurement devices need to be placed at the point of need rather than in centrally-accessed locations to assist healthcare practitioners to achieve the one hour goal. The Survive Sepsis and Healthcare Improvement Scotland Sepsis campaigns have both recommended delivery of the Sepsis Six bundle within one hour of identification of patients with sepsis. Lactate measurement is one of the elements of the Sepsis Six and the Surviving Sepsis bundles. However, sample turnaround time may be affected by delays in transportation to the ED or ICU, if the sample was drawn outside these major units. The advantage of blood gas analysers is that they have a more rapid turnaround time than central laboratory analysers. Emergency Departments (ED) and Intensive Care Units (ICU). However these devices are not portable and their availability is usually restricted to individual specialist units, e.g. As POC technology has advanced, near patient bench top blood gas analysers have been made available for lactate testing. The central laboratory approach is also associated with prolonged vein-to-brain time - the time it takes from blood draw to when the clinician becomes aware of the test results, resulting in a potential delay in clinical decision-making. This approach is associated with delays such as storing samples on ice to avoid increases in lactate due to ex-vivo anaerobic metabolism, transportation of samples to the laboratory and centrifugation before analysis leading to possible delays in the reporting of results to clinicians. The central laboratory approach involves transportation of blood samples to the laboratory via porters or air-tube systems. Lactate is measured using various analytical approaches including central laboratory methods, near patient blood gas analysers and portable Point Of Care (POC) handheld devices. Repeated and timely monitoring is therefore important in the management of patients with sepsis and in those with an elevated lactate. Persistent elevation of blood lactate of greater than 48 h in haemodynamically stable postoperative patients has been shown to be associated with an increased mortality rate. ![]() Early lactate clearance is associated with a decreased mortality rate in patients with severe sepsis. Elevated blood lactate is associated with mortality among critically ill patients. ![]() It is also an independent predictor of mortality and critical care admission. Blood lactate is a useful biomarker to identify patients at increased risk of mortality from sepsis. ![]()
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