The Centers for Medicare and Medicaid Services and the Surviving Sepsis Campaign both rushed to offer guidance on the appropriate management strategies for patients presenting with septic shock. In both cases, a lactate-guided resuscitation approach is strongly recommended. In fact, CMS incorporates its use into their mandated treatment bundles. But this obligatory performance measure is based more on opinion and conjecture than empiric data.

Resuscitating patients in septic shock with an eye toward hemodynamic perfection is likely to be detrimental. While monitoring serum lactate is unlikely to be harmful, our reflexive therapeutic response may very well be. In light of the current evidence, continued recommendations supporting a lactate-guided resuscitation strategy will only encourage over-resuscitation and the downstream harms associated with such aggressive strategies.

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