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Benefit of achieving lactate clearance versus central venous oxygen saturation target as microcirculation end point resuscitation in severe sepsis and septic shock
Critical Care volume 18, Article number: P18 (2014)
In severe sepsis and septic shock patients, lactate clearance >10% and central venous oxygen saturation (ScvO2) >70% are accepted parameters of tissue oxygenation adequacy. There is controversy of which parameters better associate with early mortality, and thus should be implemented as the microcirculation end point resuscitation [1–3]. This study was aimed to address the association of achieving either one or two targets of microcirculatory end point resuscitation and early mortality in severe sepsis and septic shock patients.
A retrospective cohort study was conducted in severe sepsis and septic shock patients (aged 18 years and older) hospitalized in the ICU, Cipto Mangunkusumo Hospital, Indonesia. Patients' early outcomes were observed during first 120 hours of hospitalization. Cox's regression analysis was used to analyse risk of early mortality in subject groups achieving lactate clearance target only, ScvO2 target only, both targets, and not achieving any target in 6 hours after onset of resuscitation.
Subjects consisted of 268 patients. Early mortality developed in 70 subjects. Fifty-four subjects achieved lactate clearance target only, 16 achieved ScvO2 target only, 138 achieved both targets, 60 did not achieve any target. Subjects who achieved both targets had a significant lowest early mortality risk (P = 0.104 compared with subjects achieved lactate clearance target only and P = 0.000 compared with remaining subject groups) (Figure 1). In subgroup analysis of subjects who achieved lactate clearance or ScvO2 target only, failure to achieve lactate clearance target associated with higher early mortality risk (hazard ratio 5.92; 95% CI 2.18 to 16.01).
Achieving both lactate clearance and ScvO2 targets in 6 hours after onset of resuscitation associates with lowest early mortality risk in severe sepsis and septic shock patients. Patients who achieve lactate clearance target only have a significant lower early mortality risk compared with those who achieve ScvO2 target only.
Jones AE, Shapiro NI, Trzeciak S, Arnold RC, Claremont HA, Kline JA: Lactate clearance vs. central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA 2010, 303: 739-746. 10.1001/jama.2010.158
Jones AE: Point: should lactate clearance be substituted for central venous oxygen saturation as goals of early severe sepsis and septic shock therapy? Yes. Chest 2011, 140: 1406-1408. 10.1378/chest.11-2560
Rivers EP, Elkin R, Cannon CM: Counterpoint: should lactate clearance be substituted for central venous oxygen saturation as goals of early severe sepsis and septic shock therapy? No. Chest 2011, 140: 1408-1413. 10.1378/chest.11-2563
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Sinto, R., Suwarto, S., Lie, K. et al. Benefit of achieving lactate clearance versus central venous oxygen saturation target as microcirculation end point resuscitation in severe sepsis and septic shock. Crit Care 18, P18 (2014). https://doi.org/10.1186/cc14021
- Septic Shock
- Severe Sepsis
- Retrospective Cohort Study
- Subject Group
- Tissue Oxygenation