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Many critically ill patients with stabilized hemo-dynamics die with signs of multiorgan failure. One of the reasons is the derangement of microcircu lation and tissue perfusion. It has been shown that microcirculatory distress left uncorrected for 24 hours is single independent predictor of mortality in sepsis. Setum lactate is the only indicator of microcirculatory changes that is monitored routinely in all critically ill patients. It has been widely believed that hyperlactatemia in sepsis is marker of tissue hypoxia and indicates the existence of oxygen debt re iulting from tisiue hypoperfusion and anaerobic glycolysis. Attempts to correct hyperlactatemia by delivering supranormal oxygen amounts have failed in septic patients. The term "shock" lactate refers to hyperlactatemia originating from oxygen debt. Human studies failed to demonitrate the relationship between hyperlactatemia and tissue hypo-perfusion in the late phase of sepsis. Adrenergic stimulation in sepsis and accelerated aerobic glycolysis have been proposed as a likely mechanism of hyperlactatemia. Both exogenous and endogenous catecholamines are correlated with septic hyperlactatemia. Aerobically generated lactate me diated by cytokines is called "stress" lartate and may serve as a marker of hypermetabolism rather than tissue hyperperfusion. Many studies and guidelines recommend targeting resuscitation to normalize lactate in septic patients. These recommendations need to be taken with reierve. Since lartate serves, under stress, as a source of energy and can be used as a fuel for oxidation as well as for glucose production, attempts to normalize lactate might be even harmiul. Although high lactate clearance, due to a correction of oxygen debt contributes to a better prognosis in sepsis, the unusual complexity of lactate makes it almost impossible to make an unambiguous therapeutic decision, when comes to a lactate-guided treatment in sepsis. [ABSTRACT FROM AUTHOR]

Copyright of Acta Chirurgica Iugoslavica is the property of Association of Yugoslav Surgeons and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Chirurgica Iugoslavica is the property of Association of Yugoslav Surgeons and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Chirurgica Iugoslavica is the property of Association of Yugoslav Surgeons and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Chirurgica Iugoslavica is the property of Association of Yugoslav Surgeons and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Chirurgica Iugoslavica is the property of Association of Yugoslav Surgeons and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Chirurgica Iugoslavica is the property of Association of Yugoslav Surgeons and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Chirurgica Iugoslavica is the property of Association of Yugoslav Surgeons and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)