The ten pitfalls of lactate clearance in sepsis

The problem with clearance Clearance is the removal of a substance from blood, expressed as a volume (milliliters) over time (minutes). However, changes in lactate levels are the sum of ongo- ing production and removal from the blood by excretion (e.g., urine, sweat) and its metabolism (e.g., uptake by cells as a direct source of energy, conversion to glucose by the liver). To talk about “lactate clearance” 1 when actually describing a decrease in blood level is wrong and misleading. Following the review of 96 studies, Vincent et al. 1 concluded that given recent evidence, measure- ments every 1–2 h would give clinically relevant data about the decrease in lactate levels.