Assessment of a point-of-care lactate monitor in emergency admissions of adult horses to a referral hospital.
Authors: Tennent-Brown Brett S, Wilkins Pamela A, Lindborg Sue, Russell Gail, Boston Raymond C
Journal: Journal of veterinary internal medicine
Summary
# Editorial Summary Blood lactate is routinely assessed in emergency equine cases as an indicator of tissue hypoxia and disease severity, yet the clinical reliability of portable lactate analysers in acute hospital settings has remained unclear. Tennent-Brown and colleagues conducted a prospective observational study comparing lactate measurements from 221 emergency-admitted horses using a point-of-care Accutrend monitor (measured in both whole blood and plasma) against a laboratory-standard NOVA blood gas analyser. Plasma samples from the portable monitor showed excellent agreement with laboratory values (correlation 0.97), with a mean difference of only 0.15 mM and narrow limits of agreement (−1.89 to +1.59 mM), particularly in horses with lactate concentrations below 5 mM and packed cell volumes below 40%; whole blood analysis on the portable device proved substantially less reliable with widened limits of agreement, especially at elevated lactate concentrations. For practitioners using point-of-care lactate monitoring in emergency situations, plasma-based measurement provides sufficiently accurate results to guide clinical decision-making and follow serial trends, whereas whole blood analysis may identify clinically significant hyperlactatemia but should not be relied upon for tracking response to treatment over time. These findings establish the Accutrend as a practical tool for emergency triage and prognosis assessment when plasma preparation is feasible, though whole blood convenience comes at the cost of analytical reliability in monitoring trends.
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Practical Takeaways
- •Use plasma samples with the Accutrend POC monitor for reliable lactate monitoring in emergency horses; whole blood samples are less dependable for tracking changes over time
- •POC plasma lactate results correlate well enough with laboratory values that point-of-care testing can guide clinical decision-making without laboratory confirmation
- •Whole blood POC lactate can identify when hyperlactatemia is clinically significant but should not be relied upon to monitor treatment response or trends
Key Findings
- •Point-of-care plasma lactate measurement showed close agreement with laboratory standards (0.97±0.01) with 95% limits of agreement of -1.89 to 1.59 mM
- •Agreement was preserved and improved in horses with lactate <5 mM and packed cell volume <40%
- •Whole blood measurement on POC monitor showed modest agreement with increased limits of agreement, making it less reliable for monitoring trends
- •POC plasma lactate is sufficiently reliable to follow trends in emergency horses but whole blood results may only identify clinically important hyperlactatemia