R.E.B.E.L.EM - March 11, 2019 - By Salim Rezaie
"Author Conclusion:
“Among patients with septic shock a resuscitation strategy targeting normalization of capillary refill time, compared with a strategy targeting serum lactate levels, did not reduce all-cause 28-day mortality.”
Clinical Take Home Point:
Although the authors conclusion makes it sound like a negative trial, as the gold standard in sepsis is to use lactate and not CRT, this study should be considered a positive trial, as it shows CRT is at least as good as a lactate-guided resuscitation strategy. Using a lactate-guided resuscitation strategy led to more fluid administration, more epinephrine used, and more vasopressors used without improvement in mortality (not statistically significant), compared to normalizing capillary refill time. In other words, with a lactate-guided resuscitation strategy, we are doing more things that don’t make a difference in mortality…Which begs the question…should we be drawing repeat lactates in septic shock?"