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.40 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.8 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)