Lactate and stepwise lactate kinetics can be used to guide resuscitation

Excerpt

We thank Dr. Thomas-Rüddel for their interest in our study of stepwise lactate kinetics-oriented hemodynamic therapy. Of course, we did not find any difference between the use of inotropes and blood transfusions in our study [1]. However, the average baseline ScvO₂ in our study was 72.1%, a value quite similar to that of the ProCESS, ARISE, and ProMISe studies [2‐4]. Therefore, a large proportion of patients in the ScvO₂ group (approximately 69% of the patients in our study) could not receive future resuscitation according to the protocol, even though the average enrollment lactate levels were around 5.5 mmol/L. However, the patients with high lactate levels could still enter the lactate kinetics group. An optimal resuscitation target should be able to generate sufficient driving force for the specific clinical treatment so that it can better guide the clinical therapy. Lactate, which reflects tissue hypoperfusion, has been recommended as a valuable resuscitation parameter by new Surviving Sepsis Campaign guidelines [5, 6]. Lactate kinetics, defined by Vincent [7, 8], represent a balance between lactate production and elimination and can represent a resuscitation parameter [9, 10]. In our study, it was obvious that, compared with ScvO₂, lactate kinetics could not only support a proper initial resuscitation, but could also guide the whole therapeutic process. …