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- Title
Serial lactate measurements to guide resuscitation: more evidence not to?
- Authors
Legrand, Matthieu; van der Horst, Iwan C. C.; De Jong, Audrey
- Abstract
The article discusses the use of serum lactate as a biomarker for tissue perfusion and fluid administration in critically ill patients, particularly those with sepsis. The inclusion of serum lactate in the criteria for septic shock is based on its prognostic value. However, evidence supporting the use of lactate to guide fluid resuscitation is limited. Several randomized trials have shown no improvement in survival with a lactate-guided strategy. The article suggests that serum lactate is not a specific indicator of hypoperfusion and that other factors can affect its levels. A recent study found that a restrictive fluid therapy strategy did not affect the resolution of hyperlactatemia compared to a standard fluid therapy strategy. The article concludes that while lactate measurement is easy and has prognostic value, better integration with clinical phenotyping and the use of peripheral perfusion assessment may provide more individualized strategies for fluid therapy in sepsis. Ongoing clinical trials will provide further insights into the optimal approach.
- Subjects
HYPERLACTATEMIA; LACTATES; LACTATION; RESUSCITATION; SEPTIC shock
- Publication
Intensive Care Medicine, 2024, Vol 50, Issue 5, p728
- ISSN
0342-4642
- Publication type
Article
- DOI
10.1007/s00134-024-07411-w