Clinical evaluation of a novel subcutaneous lactate monitor

Nitsan Dror; John Weidling; Sean White; Francesca Ortenzio; Samir Shreim; Mark T Keating; Hoang Pham; Shlomit Radom-Aizik; Elliot Botvinick

doi:10.1007/s10877-021-00685-1

Clinical evaluation of a novel subcutaneous lactate monitor

J Clin Monit Comput. 2022 Apr;36(2):537-543. doi: 10.1007/s10877-021-00685-1. Epub 2021 Apr 10.

Authors

Nitsan Dror^{1

2}, John Weidling³, Sean White³, Francesca Ortenzio⁴, Samir Shreim³, Mark T Keating³, Hoang Pham¹, Shlomit Radom-Aizik¹, Elliot Botvinick^{5

6}

Affiliations

¹ Pediatric Exercise and Genomics Research Center, Department of Pediatrics, School of Medicine, University of California Irvine, Irvine, USA.
² Pediatric Department, Meir Medical Center, Child Health and Sports Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
³ Beckman Laser Institute and Medical Clinic, University of California Irvine, Irvine, USA.
⁴ Department of Dermatology, University of California Irvine Health, Irvine, USA.
⁵ Beckman Laser Institute and Medical Clinic, University of California Irvine, Irvine, USA. elliot.botvinick@uci.edu.
⁶ Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California Irvine, Irvine, USA. elliot.botvinick@uci.edu.

Abstract

Lactate levels are commonly used as an indirect measure to assess metabolic stress in clinical conditions like sepsis. Dynamic lactate measurements are recommended to assess and guide treatment in patients with shock and other critical care conditions. A minimally invasive, continuous lactate monitor has potential to improve clinical decisions and patient care. The purpose of the study was to evaluate continuous lactate measurements of a novel enzymatic Continuous Lactate Monitor (CLM) developed in our laboratory. Lactate levels were monitored during incremental cycling exercise challenges as a tool for hyperlactatemia. Six healthy individuals 18-45 y/o (4 males, 2 females) participated in the study. CLM devices were inserted subcutaneously in the postero-lateral trunk below the renal angle, one hour before the exercise challenge. Each exercise challenge consisted of a 3 to 12-min warm up period, followed by up to 7, 4-min incremental workload bouts separated by rest intervals. Continuous lactate measurements obtained from CLM were compared with commercial lactate analyzer (Abbott iSTAT) measurements of venous blood (plasma) drawn from the antecubital vein. Blood was drawn at up to 25 time points spanning the duration of before exercise, during exercise, and up to 120 min post exercise. Area under the curve (AUC), and delay time were calculated to compare the CLM readings with plasma lactate concentration. Average plasma lactate concentration increased from 1.02 to 16.21 mM. Ratio of AUC derived from CLM to plasma lactate was 1.025 (0.990-1.058). Average dynamic delay time of CLM to venous plasma lactate was 5.22 min (2.87-10.35). Insertion sites examined 48 h after CLM removal did not show signs of side effects and none required medical attention upon examination. The newly developed CLM has shown to be a promising tool to continuously measure lactate concentration in a minimally invasive fashion. Results indicate the CLM can provide needed trends in lactate over time. Such a device may be used in the future to improve treatment in clinical conditions such as sepsis.

Keywords: Continuous lactate monitor; Exercise physiology; Lactate; Lactic acid; Optode; Real-time monitoring.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Critical Care
Female
Humans
Lactic Acid
Male
Monitoring, Physiologic
Sepsis*
Shock*

Substances

Lactic Acid

Abstract

Publication types

MeSH terms

Substances

Grants and funding