Persistent sepsis-induced hypotension without hyperlactatemia: Is it really septic shock?

Lactate profiles of pediatric shock patients in Cipto Mangunkusumo General Hospital 2015: a pilot study

“…Previous studies found that lactate did not increase in some adult with sepsis (alactatemia). 7,11,12 In this pilot study, we find similar results, as 63%of our pediatric shock patients have alactatemia. Hence we conclude that lactate clearance, particularly in alactatemic conditions, can not be used as a means of assessing the success of fluid resuscitation.…”

“…5 Nevertheless, Hernandez et al found that 1/3 of adult patients with septic shock had alactatemia, and a lower mortality rate. 7 The underlying condition that causes alactatemia is unknown, but it might be due to differences in metabolism in children and adults. 8 The aim of this study was to evaluate lactate profiles, possible factors affecting lactate levels, and related outcomes in pediatric patients with shock in the ER or PICU.…”

Hyperlactatemia and hypotension: looking at septic shock from different perspectives

“…In an earlier retrospective study, the same authors had shown even wider differences in a group of 302 patients adimitted to ICU for septic shock. Mortality was 7.7% among the 104 patients who never developed lactates >2.4 mmol/L, and 42.9% among the 198 patients who had a value of lactates >2.4 mmol/L at least once in the first 24 h. 13 From these studies we can infer that, in accordance with a wider literature, patients with higher lactates have a worse prognosis. It seems also clear that the group of hypotensive patients is a very heterogeneous one since it may contain patients who are just hypovolemic and patients who are more or less severely underperfused.…”

Counterpoint: Should Lactate Clearance Be Substituted for Central Venous Oxygen Saturation as Goals of Early Severe Sepsis and Septic Shock Therapy? No

“…2 Pathological D o 2 dependency is a result of a progressive impairment of OER, which is accompanied by a markedly increased Scv o 2 /Sv o 2 (venous hyperoxia) and a hyperdynamic circulation. When D o 2 is insuffi cient, o 2 decreases, and increased lactate levels 17 Lactate levels over time can increase (negative clearance), stay the same, or decrease (positive clearance) after intervention ( Fig 2 ). Not only is the direction of clearance impor tant but also the magnitude of change.…”