Lactate
Lactate is an important marker of severe sepsis and elevated levels (4 mmol/L) are associated with a high mortality rate. A recent multicenter randomized trial by Jones compared lactate clearance (10%) with SCVO2(70%) as a quantitative resuscitation endpoint and found it to be noninferior. This suggests that measuring peripheral lactate levels instead of SCVO2 (which requires a CVC) may spark a noninvasive pathway of quantitative resuscitation. However, this possibility has yet to be included in consensus guidelines, which currently state a goal of lactate normalization. Importantly, SCVO2 and lactate need not be used to the exclusion of one another, and when available, can be used concurrently. In the absence of CVCs, checking serial lactate levels for clearance can be used to guide therapy (above)