Protocol to manage high blood lactate in sepsis1-150
| Give intravenous fluid volume bolus of 10–20 ml/kg of colloid or normal saline |
|---|
| Continuously monitor |
| • arterial blood pressure |
| • central venous pressure (CVP) |
| • heart rate |
| • cutaneous oxygen saturation (SpO2) |
| • urine output |
| Maintain CVP at 8–12 mm Hg with fluid volume |
| Up to 40–60 ml/kg might be required in the first six hours |
| Optimise SpO2 with oxygen and mechanical ventilation |
| Transfuse with packed cells if haemoglobin < 100 g/l |
| Give clotting products as volume if there is a coagulopathy, but beware of hypotension caused by fresh frozen plasma |
| Repeat lactate; if still high or blood pressure low, add dopamine at 5 μg/kg/min |
| Apply mechanical ventilation to reduce respiratory muscle oxygen consumption and allow redistribution of cardiac output to vital organs |
| Increase inotropic support if lactate still rising |
| Consider that catecholamines, especially adrenaline (epinephrine), might also cause high lactate concentrations |
| If the child is receiving adrenaline, and has an acceptable blood pressure but a rising lactate, reducing the adrenaline infusion rate might lower lactate |
| Titrate the inotrope to the lowest infusion rate that will maintain |
| • a blood pressure in the normal range for age |
| • a urine output > 1 ml/kg/hour |
| • a reduction in lactate |
| If lactate continues to rise despite these measures, consider the use of extracorporeal life support |
↵1-150 Assumes appropriate antibiotics have been given.