Lactate clearance as a target of therapy in sepsis: A flawed paradigm

Abstract

An increased blood lactate level is widely believed to be a marker of inadequate oxygen delivery and an- aerobic metabolism. Furthermore, the rate of decline in lactate concen- tration (lactate clearance) has been recommended as an end-point of early goal directed therapy in critical ill patients with sepsis. We provide compelling data that an elevated lac- tate concentration is a consequence of increased aerobic glycolysis as part of the stress response and that titrat- ing therapy to the rate of decline in lactate concentration is a potentially harmful endeavour. Furthermore, an increased lactate concentration may be an important adaptive survival re- sponse during critical illness.