The capillary refill time improves more rapidly than lactate in response to the systemic flow increments. It can be assessed more frequently during a septic shock resuscitation. On the contrary, hyperlactatemia exhibits a slower recovery in septic shock survivors which can be explained by the delayed resolution of non hypoperfusion related sources. Thus, targeting lactate normalization may be associated with bad outcomes. The randomized controlled trial comparing CRT vs. LT resuscitation in early septic shock. This trial suggested lower mortality and demonstrated significantly less organ dysfunction and treatment intensity in the CRT group.
Stress-related hyperlactatemia is triggered by the neurohumoral response to sepsis that generates aerobic lactate production in skeletal muscles through the beta-2-epinephrine stimulation. It was hypothesized that in SEPSIS-3 septic shock patients evolved with standard CRT at two hours. The T0 randomization to the LT arm was associated with higher mortality compared to patients randomized to the CRT arm. The primary aim of the study was to determine if septic shock patients evolving with standard CRT at T2 exhibited a higher mortality and organ dysfunction after being randomized to the arm at T0 than when randomized to the CRT arm. The septic shock patients with standard CRT received more therapeutic interventions and greater organ dysfunction when assigned to the lactate group. This could be associated with worse outcomes as well.