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Volume 18 Supplement 2

Sepsis 2014

  • Poster presentation
  • Open Access

Benefit of achieving lactate clearance versus central venous oxygen saturation target as microcirculation end point resuscitation in severe sepsis and septic shock

  • R Sinto1,
  • S Suwarto1,
  • KC Lie1,
  • D Widodo1 and
  • HT Pohan1
Critical Care201418(Suppl 2):P18

https://doi.org/10.1186/cc14021

Published: 3 December 2014

Keywords

Septic ShockSevere SepsisRetrospective Cohort StudySubject GroupTissue Oxygenation

Introduction

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 [13]. 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.

Methods

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.

Results

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).
Figure 1
Figure 1

Survival analysis of groups based on target achievement.

Conclusion

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.

Authors’ Affiliations

(1)
Division of Tropical and Infectious Disease, Department of Internal Medicine, Jakarta, Indonesia

References

  1. 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.2010.158View ArticlePubMedPubMed CentralGoogle Scholar
  2. 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.11-2560View ArticlePubMedPubMed CentralGoogle Scholar
  3. 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.11-2563View ArticlePubMedPubMed CentralGoogle Scholar

Copyright

© Sinto et al.; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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