For decades, lactate has served as one of the primary markers used to guide resuscitation in septic shock. Elevated lactate levels are associated with worse outcomes and have become deeply embedded in sepsis protocols.
However, lactate is an imperfect marker of tissue hypoperfusion. Adrenergic stimulation, impaired clearance, and metabolic alterations can all contribute to elevated lactate levels.
The investigators behind ANDROMEDA-SHOCK questioned whether targeting a simple bedside marker of peripheral perfusion might provide a better resuscitation strategy.
ANDROMEDA-SHOCK was a multicenter randomized controlled trial published in 2019. Patients with septic shock were randomized to a resuscitation strategy targeting either normalization of capillary refill time or lactate clearance.