Abstract
INTRODUCTION: Although serum lactate levels have served as an important biomarker of illness severity in sepsis patients, lactate should not be the only criterion to guide treatment to enhance survival. Traditionally, clinicians have been instructed by such organizations as the Surviving Sepsis Campaign and its guidelines regarding lactate concentrations and tissue hypoperfusion. As this literature review will show, a combination of lactate with other biomarkers can serve as a more reliable predictor of sepsis mortality and thus guide appropriate interventions. METHODS: A search was conducted using the PubMed database. After formulating several research questions related to the topic, relevant keywords were generated. These produced sufficiently many articles related to sepsis resuscitation, lactate levels, and hemodynamic resuscitation. RESULTS: Hyperlactatemia is not the main criterion by which clinicians should be guided when treating patients with sepsis or in septic shock. Rather, lactate levels and lactate clearance should be used along with other assessments to determine appropriate interventions. Oxygen perfusion might do harm if a patient is not suffering from tissue hypoxia; thus, resuscitation must be based on microcirculatory dynamics and not macro hemodynamics. CONCLUSION: Decreased lactate clearance should not be the only criterion of early goal-directed therapy in severly ill sepsis patients. Hemodynamic resuscitation should be implemented based on actual oxygen demand, and measures using lactate with other biomarkers have been shown more reliable in predicting mortality than hyperlactatemia alone.