The detection of tissue hypoxia and its correction is one of the aim of the hemodynamic monitoring. Classical hemodynamic variable often fail to achieve this goal. Lactate measurements may be a good indicator of tissue hypoxia. Selected review of the articles on lactate in critically ill patients. Tissue hypoxia is associated with an increase in blood lactate levels. However lactate can also be produced in aerobic conditions, in inflammated tissues, and lactate clearance is often decreased in critically ill patients. Whatever its origin, blood lactate levels have a strong predictive value. The interpretation of blood lactate levels is difficult. Nevertheless, monitoring blood lactate levels can be useful to detect tissue hypoxia and to monitor the effects of therapy.