The 2024 revision to the Surviving Sepsis Campaign guidelines landed with relatively modest fanfare in the human critical care world—but for those of us watching from the veterinary side of the fence, several of the updates carry meaningful translational weight.
The Shift Away from ScvO₂
The previous guidelines leaned heavily on central venous oxygen saturation as a resuscitation endpoint. The 2024 update formally deemphasizes ScvO₂ in favor of lactate clearance, which aligns with what retrospective veterinary data have suggested for several years. This is welcome because ScvO₂ monitoring in dogs and cats requires central venous catheterization—a practical constraint that limits its real-world use in most emergency settings.
If your practice already has lactate-guided resuscitation baked into your sepsis protocol, you are ahead of the curve. If not, this is a good moment to revisit your approach.
Vasopressor Timing
One of the more provocative updates concerns earlier vasopressor initiation—specifically, the recommendation to start norepinephrine earlier in the resuscitation sequence rather than as a last resort after large-volume crystalloid loading. The theoretical benefit is reduction of fluid-related complications (edema, coagulopathy, abdominal compartment syndrome) by achieving MAP targets more rapidly with smaller fluid volumes.
In veterinary practice, vasopressor use remains underutilized relative to what clinical evidence would suggest. Norepinephrine CRI is practical in most ICU settings, and the updated human guideline provides additional impetus for earlier integration into our sepsis protocols.
What Doesn't Translate
I want to be clear-eyed about the limits of translation. The human sepsis guidelines are built on a body of evidence involving tens of thousands of patients across dozens of randomized controlled trials. Veterinary sepsis research operates at a fraction of this scale. Direct guideline adoption without critical appraisal of species differences, institutional resources, and patient population characteristics would be a mistake.
What the human literature offers us is a framework—not a prescription. The clinician's job is to apply the framework with judgment.
Practical Implications
For practitioners without access to point-of-care lactate, this update is a reminder that investment in this technology pays clinical dividends. For those with lactate capability, ensure your team is measuring it early, measuring it serially, and acting on the trend rather than the snapshot.
We'll have a full evidence review on lactate-guided resuscitation in the articles section for those who want the deeper dive.