Quantifying the volume of fluid resuscitation required to normalize lactate in septic patients (Cohort Study)

Background: Patients with sepsis have significant mortality and morbidity that may improve by normalization of lactate as indication of adequate resuscitation. We sought to quantify the volume of fluid associated with correction of lactate in septic surgical patients. Material and methods: A retrospective review was conducted in all patients with elevated lactate who were admitted to the SICU at a Level I trauma center from February 2016 to April 2018. Patients ≥18 years with sepsis, septic shock, infection, and lactate >2.5 mmol/l with subsequent lactate follow up were included. Patients on dialysis, liver failure, and trauma patients who received massive transfusion were excluded. Data was collected on patients’ demographics, hospital length of stay (LOS), mortality and volume of fluid given. The primary outcome was the volume of fluid required to correct lactate by 1 mmol/l. Pearson correlation coefficient was calculated to evaluate the association between fluid volume and lactate level. Results: Forty-eight patients were included. The mean age was 67 (14.2) years, 56.3% were males, and mortality was 22%. The mean elevated lactate was 4.90 (3.02) mmol/l. An average of 1372 (1809) cc of fluid was needed to reduce lactate by 1 mmol/l. The average time for correction was 5.2 (5.6) hours. There was weak correlation between resuscitation fluid volume and lactate correction (r = 0.29, p = 0.05). Conclusions: About 1400 cc of fluid was required to correct the lactate by 1 mmol/l. This value can help guide resuscitation in septic surgical patients. The weak correlation between resuscitation fluid volume and lactate correction highlights the importance of other interventions including the early administration antibiotics and source control.