[Sepsis Groups] Feedback on this document

[Arnold, Ryan]

The serial assessment of lactates during active resuscitation is an important practice that is not yet standard of care, however can be very helpful in assessing a patient's response to early resuscitation. The inclusion of lactate >2 is in line with the recommendations and supported by multiple studies to be abnormal and identifying a higher risk patient population.  

While the consensus definitions for septic shock are limited to refractory hypotension after 20 cc/kg fluid bolue, it is important to realize that any  lactate > or = 4.0 mmol/L qualifies the patient for the sepsis resuscitation bundle as outlined by the SSC guidelines. 

I would suggest a change in the "Initial Lactate" category.  If the lactate is >4, at any time, then the patient's response to interventions (e.g. fluid boluses) does not define a less invasive strategy under the current guidelines.  The use of routine serial lactates during the early resuscitation of severe sepsis and septic shock is an excellent strategy that can be very helpful defining the patients response to therapy. 


Ryan Arnold, MD
Assistant Professor
Department of Emergency Medicine
Cooper University Hospital
UMDNJ Robert Wood Johnson Medical School at Camden
(609)605-3828
________________________________________
From: sepsisgroups-bounces at lists.sepsisgroups.org [sepsisgroups-bounces at lists.sepsisgroups.org] On Behalf Of Robert Hattabaugh [RHattabaugh at johnsonmemorial.org]
Sent: Tuesday, July 28, 2009 3:12 PM
To: sepsisgroups at lists.sepsisgroups.org
Subject: [Sepsis Groups] Feedback on this document

  Hello, I wanterd to see if anyone would give me some feedback on this document.

Thanks Robert


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