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Published in: Intensive Care Medicine 5/2024

18-04-2024 | Septicemia | Editorial

Serial lactate measurements to guide resuscitation: more evidence not to?

Authors: Matthieu Legrand, Iwan C. C. van der Horst, Audrey De Jong

Published in: Intensive Care Medicine | Issue 5/2024

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Excerpt

Serum lactate has long been considered a biomarker of tissue perfusion and a trigger for fluid administration in critically ill patients, especially in those with sepsis [1]. The Sepsis-3 consensus defined septic shock based on vasopressor requirement to maintain a mean arterial pressure of 65 mmHg or greater and a serum lactate level greater than 2 mmol/L (> 18 mg/dL) in the absence of hypovolemia incorporated plasma lactate in the criteria for septic shock [2]. The choice to include serum lactate was based on prognostic stratification, with patients with hypotension requiring vasopressors and elevated serum lactate levels with higher mortality than patients meeting only one criterion (i.e., isolated elevated lactate or hypotension requiring vasopressors without elevated lactate). Finally, the panel acknowledged that serum lactate measurements are relatively commonly available [2]. The 2021 edition of the Surviving Sepsis Campaign (SCCM) suggests guiding resuscitation to decrease serum lactate levels in patients with elevated lactate levels. Despite the widespread use of lactate to guide fluid resuscitation, evidence to support this practice is very limited, and the panel issued a weak recommendation [3]. …
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Metadata
Title
Serial lactate measurements to guide resuscitation: more evidence not to?
Authors
Matthieu Legrand
Iwan C. C. van der Horst
Audrey De Jong
Publication date
18-04-2024
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 5/2024
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-024-07411-w

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