see also:

• sepsis / septicaemia
• the shocked hypotensive patient
• serum lactate
  • https://emcrit.org/isepsis/isepsis-lactate-myths/
• RCH guidelines - septic shock

• 2008 International guidelines for management of severe sepsis and septic shock from the Surviving Sepsis Campaign in the USA. Hosted on NICS blog
  • survivingsepsis.org
• “lactate clearance but not initial lactate level is significantly associated with a decreased mortality rate. Furthermore, Nguyen et al. were able to quantify this as an 11% decrease in in-hospital mortality for each 10% increase in lactate clearance at 6 hours; Kleigel et al. also quantified this as an increased mortality rate at 6 months with an odds ratio of 1.49 per mmol/L of lactate at 48 hours. The most recent paper by Donnino et al. found no difference between survivors and non-survivors with respect to initial lactate level. Multivariate regression analysis again confirmed that lactate clearance at 12 hours was singularly predictive of 24 hour survival. In addition, lactate clearances at 6, 12 and 24 hours were the only factors significantly associated with survival to hospital discharge. ”
  • BestBets.org - lactate as predictor of mortality in shock