Is lactate administration necessary after a diagnosis of sepsis (Systemic Inflammatory Response Syndrome)?

From the Guidelines

Lactate administration is not necessary after a diagnosis of sepsis, but rather lactate levels should be monitored to guide resuscitation efforts. The Surviving Sepsis Campaign guidelines suggest guiding resuscitation to normalize lactate in patients with elevated lactate levels as a marker of tissue hypoperfusion 1. This approach is based on the understanding that elevated lactate levels indicate tissue hypoxia and that normalizing lactate levels can improve outcomes. The guidelines recommend an initial target mean arterial pressure of 65 mmHg in patients with septic shock requiring vasopressors 1.

Key Points

• Lactate levels should be monitored to guide resuscitation efforts
• Elevated lactate levels indicate tissue hypoperfusion and should be normalized
• Initial target mean arterial pressure should be 65 mmHg in patients with septic shock requiring vasopressors
• Fluid resuscitation should be guided by frequent reassessment of hemodynamic status

Rationale

The rationale behind monitoring lactate levels is to assess the severity of tissue hypoperfusion and to guide resuscitation efforts. Elevated lactate levels are associated with increased mortality and morbidity, and normalizing lactate levels can improve outcomes 1. The use of lactate levels to guide resuscitation efforts is a key component of the Surviving Sepsis Campaign guidelines.

Recommendations

• Monitor lactate levels in patients with sepsis to guide resuscitation efforts
• Use lactate levels to assess the severity of tissue hypoperfusion
• Normalize lactate levels to improve outcomes
• Use fluid resuscitation and vasopressor therapy as needed to achieve target mean arterial pressure and normalize lactate levels 1

From the Research

Lactate Administration in Sepsis

• The administration of lactate is not explicitly mentioned as a necessary step in the management of sepsis in the provided studies 2, 3, 4, 5, 6.
• However, lactate measurement is recommended as part of the initial assessment and management of sepsis, particularly in the context of identifying patients with septic shock 5.
• The Surviving Sepsis Campaign Hour-1 bundle recommends lactate measurement, along with other interventions such as broad-spectrum antibiotics administration and fluid resuscitation, to be initiated within 1 hour of sepsis diagnosis 5.
• The use of lactate levels to guide fluid and vasopressor therapy is also mentioned, highlighting the importance of lactate measurement in the management of sepsis 5.

Fluid Management in Sepsis

• Fluid resuscitation is a fundamental component of sepsis therapy, with the goal of restoring perfusion and preventing organ dysfunction 2, 3, 4, 6.
• The optimal approach to fluid management in sepsis remains uncertain, with different studies suggesting varying strategies for fluid administration 4, 6.
• The use of balanced crystalloids, such as Ringer's lactate, is recommended as a reasonable approach for initial fluid resuscitation 6.
• The administration of fluids should be guided by the patient's hemodynamic response, with consideration of the risks and benefits of subsequent fluid administration 6.

Sepsis Management

• Sepsis management involves a range of interventions, including early goal-directed therapy, broad-spectrum antibiotics administration, and source control 2, 3, 5.
• The completion of specific bundles, such as the Surviving Sepsis Campaign Hour-1 bundle, is time-sensitive and critical for improving outcomes in sepsis 5.
• The use of vasopressors, such as norepinephrine and dopamine, is recommended for patients with septic shock who require vasopressor support 2, 5.