EM Ottawa - By Garrick Mok - May 7, 2020
"Take Home Points
There is no perfect marker for perfusion in sepsis. These patients are complicated to manage, and there are many factors that you have to piece together to improve their perfusion. Some key points to remember include:
- MAP ≠ perfusion
- Ensure that you’re utilizing other markers to assess perfusion in conjunction with MAP
- Lactate ≥2 is a prognosticator of mortality in sepsis
- Consider differential for Type A vs. Type B lactic acidosis
- Lactate clearance is associated with improved survival
- Recommend repeating lactates q2h and targeting 10 – 20% clearance
- Goal is normalization at 6hrs
- Caution in patients with liver and renal failure
- Mottling score is associated with mortality
- CRT can be used in conjunction with lactate to guide resuscitation"