Point-of-care lactate measurement in resource-poor settings

Early identification of sepsis and septic shock, along with its aggressive goal directed therapy, is proven to improve outcomes in paediatric patients.1 The American College of Physicians and Surgeons has published clinical guidelines that have been incorporated into the American Heart Association Paediatric Advanced Life Support courses, which indicate early recognition and management of septic shock in the paediatric age group improves survival in a community-based setting.1 Although a diagnosis of septic shock in adults requires cardiovascular dysfunction and hypotension, it is much harder to identify in children and is likely evolving long before any clear systemic, clinical decompensation.1 Emergency departments (EDs) around the world are the main entry point to hospitals and deal with a high throughput. In low-and-middle-income countries (LMICs), this burden is compounded by resource restraint. Factors such as the transport of the testing samples to the primary testing facility result in an inevitable delay to report the result, which, in turn, leads to a delay in the initiation of the appropriate management of the patient. Aggressive therapy with fluid resuscitation and possible inotropic support drastically reduces the mortality rate: with each passing hour of unrecognised and untreated cases, the mortality increases twofolds.1 The capacity to make rapid decisions and start appropriate treatment early in time may decrease the patients stay in the ED, reducing the financial strain and occupancy burden in the presence of limited resources. …