The Lactate “Debate” with Dr Seth Trueger


I was lucky enough to record a new podcast with Dr Seth Trueger – inspired by the recent online discussions around lactate, or more specifically lactate-clearance as a marker, or a goal of therapy in the treatment of septic patients.

This is a topic my team will be covering at the ACEM Winter Symposium here in Broome this weekend.  It has been a weird preparation for our discussion in front of a whole bunch of ED Specialists – everytime I sit down to plan the talk I see another FOAMed resource or opinion which changes the landscape.

This podcast needs a bit of background in order for the whole conversation to make a bit of sense.

Lactate Clearance has been around for 10 years or so as a therapeutic goal – or at least of a marker of “winning” when we are resuscitating septic patients.

Nguyen, Rivers and co popularised lactate clearance as a marker of improvement in 2004 – a few years after the original EGDT trials by Rivers.

Then in 2009 Jones et al did a comparison between SvcO2 and lactate as markers to guide therapy in sepsis resuscitation – they showed they both worked equally as well.  Jones et al showed it was “non-inferior” to SvCO2 to guide resuscitation.

Then in March this year Prof. Paul Marik and Dr Renaldo Bellomo wrote a review article titled “Lactate clearance as a target of therapy in sepsis: a flawed paradigm.”  In this paper they utilise a lot of pathophysiology and common sense to show why the traditional concept of lactate as a marker of anaerobic metabolism was a flawed concept.

This provoked a short sharp retort from Dr Scott Weingart on his Emcrit podcast (much shorter than our longish dissection!)  Have a listen to his thoughts then carry on to our discussion.

I was supposed to be taking the position that lactate clearance is a flawed concept – and Seth was taking the pro stance.  But we pretty much ended up agreeing on everything!

OK.  Onto the podcast.  Love to hear you comments  Play below or DOWNLOAD Direct here



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