Evaluating the Possibility of Translating Technological Advances in Non-Invasive Continuous Lactate Monitoring into Critical Care

Abstract

Lactate is widely measured in critically ill patients as a robust indicator of patient deterioration and response to treatment. Plasma concentrations represent a balance between lactate production and clearance. Analysis has typically been performed with the aim of detecting tissue hypoxia. However, there is a diverse range of processes unrelated to increased anaerobic metabolism that result in the accumulation of lactate, complicating clinical interpretation. Further, lactate levels can change rapidly over short spaces of time, and even subtle changes can reflect a profound change in the patient’s condition. Hence, there is a significant need for frequent lactate monitoring in critical care. Lactate monitoring is commonplace in sports performance monitoring, given the elevation of lactate during anaerobic exercise. The desire to continuously monitor lactate in athletes has led to the development of various technological approaches for non-invasive, continuous lactate measurements. This review aims firstly to reflect on the potential benefits of non-invasive continuous monitoring technology within the critical care setting. Secondly, we review the current devices used to measure lactate non-invasively outside of this setting and consider the challenges that must be overcome to allow for the translation of this technology into intensive care medicine. This review will be of interest to those developing continuous monitoring sensors, opening up a new field of research.

Electroanalytical overview: screen-printed electrochemical sensing platforms for the detection of vital cardiac, cancer and inflammatory biomarkers

“…For advancements in electrochemical lactate sensing and their transition to critical care we direct the reader towards a recent review. 161 Recent developments in advanced electrochemical, immunological or magnetic sensors provide rapid highly sensitive and selective detection of PCT and CRP which might offer an alternative solution to current testing methods. There have been several reports for the detection of CRP alone primarily following similar trends to that seen in previous sections, namely the use of MIPs 162 or nanomaterials and nanoparticles with a view to improve electrode performance and EDC/NHS or glutaraldehyde coupling to immobilise recognition elements.…”

“…For advancements in electrochemical lactate sensing and their transition to critical care we direct the reader towards a recent review. 161…”

Wearable device for continuous sweat lactate monitoring in sports: a narrative review

“…Lactic acid exists in equilibrium with lactate, and the equilibrium is maintained by the body’s pH level ( Schmidt et al, 2021 ). At the normal body pH of 7.4, lactic acid exists predominantly as lactate, which has one less hydrogen ion ( Crapnell et al, 2021 ; Certo et al, 2022 ). However, in many studies, the terms “lactic acid” and “lactate” are used interchangeably ( Cairns, 2006 ; Hall et al, 2016 ).…”

Hyperlactatemia and other perioperative metabolic disturbances in neuroanesthesia

“…Technological advancement has made it possible to measure lactate noninvasively [ 34 ]. Saliva and sweat are among the most commonly researched bodily fluids.…”