Does Lactate-Guided Therapy in the ICU Lead to Better Outcomes?

Early goal-directed therapy (EGDT) leads to better outcomes in septic patients. EGDT includes three sequential physiologic goals: intravenous fluids to achieve a central venous pressure of 8 to 12 mm Hg, pressors to attain a mean arterial pressure ≥65 mm Hg, and inotropes or red blood cell transfusions to achieve central venous oxygen saturation (ScvO₂) ≥70% or mixed venous saturation ≥65%. Lactate levels, like ScvO₂, are a measure of tissue hypoxia; however, whether monitoring and acting on lactate levels improve septic patients' outcomes is unclear.

In 2006 and 2007, 348 patients with sepsis and lactate levels ≥3 mEq/L from four Dutch intensive care units (ICUs) were randomized to lactate-guided or control groups. Both groups received resu…