From the Guidelines
The best indicator of adequate resuscitation in septic shock is E. Decreased lactate level. When treating septic shock, monitoring lactate clearance provides the most reliable evidence that tissue perfusion is improving. During septic shock, poor tissue perfusion leads to anaerobic metabolism, resulting in lactate production. As resuscitation efforts succeed and oxygen delivery to tissues improves, lactate levels decrease, indicating that cellular metabolism is returning to normal. While normal blood pressure, pulse, urine output, and improved mental status are important clinical parameters to monitor, they may normalize before tissue perfusion is truly adequate. Serial lactate measurements offer a more objective biochemical marker that directly reflects cellular oxygenation status. Current guidelines recommend targeting lactate normalization as a goal of resuscitation, with decreasing levels (typically aiming for >10-20% reduction over 2-6 hours) suggesting that interventions like fluid resuscitation, vasopressors, and antimicrobial therapy are effectively reversing the underlying pathophysiology of septic shock 1. Some key points to consider when using lactate as a marker of resuscitation include:
- Lactate clearance is a more reliable indicator of tissue perfusion than absolute lactate levels 1
- A decrease in lactate levels over time is associated with improved outcomes in septic shock 1
- Lactate-guided resuscitation has been shown to be effective in reducing mortality in septic shock 1
- Other clinical parameters, such as urine output and mental status, should also be monitored in conjunction with lactate levels to ensure adequate resuscitation 1
From the Research
Indicators of Adequate Resuscitation in Septic Shock
- The best indicator of adequate resuscitation in septic shock is a topic of ongoing research and debate 2, 3, 4, 5, 6.
- According to some studies, decreased lactate level is a key indicator of adequate resuscitation, as it reflects improved tissue perfusion and oxygen delivery 2, 3.
- However, other studies suggest that lactate is an unreliable indicator of tissue hypoxia in sepsis, and that its levels may not correlate with traditional indicators of perfusion 4.
- Other potential indicators of adequate resuscitation include:
- A multimodal approach to perfusion monitoring, incorporating multiple variables and parameters, may be necessary to optimize resuscitation in septic shock patients 5.