Early Lactate-Guided Resuscitation in Septic Shock Patients in the ICU
Abstract
Background: Septic shock is a critical condition in the intensive care unit (ICU) with persistently
high mortality. Early resuscitation plays a key role in improving tissue perfusion, and serum lactate
and lactate clearance have been used as markers of hypoperfusion and response to resuscitation.
However, the effectiveness of early lactate-guided resuscitation on clinical outcomes remains to
be systematically evaluated. Objective: To assess the effectiveness of early lactate-guided
resuscitation on clinical outcomes in patients with septic shock treated in the ICU. Methods: This
study was conducted as a systematic review in accordance with the PRISMA guidelines. A
literature search was performed in the PubMed database through 2025. Studies involving adult
patients with septic shock in the ICU that used serum lactate or lactate clearance as a target for
early resuscitation were included. Study selection was conducted through title and abstract
screening, followed by full-text review based on predefined inclusion and exclusion criteria. Data
were synthesized narratively. Results: Of the 32 articles identified, five studies met the inclusion
criteria, comprising three randomized controlled trials and two systematic reviews/meta-analyses.
Overall, early lactate-guided resuscitation demonstrated clinical outcomes that were at least non-
inferior to conventional resuscitation strategies, with a trend toward improved mortality, shorter
ICU length of stay, and better clinical parameters in several studies. Conclusion: Early lactate-
guided resuscitation is an effective and clinically relevant strategy in the management of septic
shock in the ICU. Serial monitoring of serum lactate and lactate clearance may be considered as
targets for early resuscitation to support improved patient outcomes.Keywords: septic shock;
lactate; lactate clearance; early resuscitation; ICU
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