EBQ:Lactate clearance vs central venous oxygen saturation

incomplete Journal Club Article

Jones AE.. "Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial". JAMA. 2010. 303(8):739-746.
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Clinical Question

Is lactate clearance as good as SVO2 as a measure of oxygen delivery to tissues in patients presenting with severe sepsis and septic shock?

Conclusion

For patients with septic shock who were treated by normalizing CVP and MAP; attempt to normalize lactate clearance as opposed to normalize SVO2 showed no significant difference in in-hospital mortality.

Major Points

Inclusion Criteria

>17 years old AND
confirmed or presumed infection meeting criteria for severe sepsis or septic shock:
- 2 or more SIRS criteria AND
- SBP <90 after 20 mL/kg bolus or blood lactate at least 36 mg/dL

Exclusion Criteria

Pregnancy
Primary diagnosis other than sepsis
Likely surgery required within 6 hours of diagnosis
Contraindication to chest or neck CVC
Cardiopulmonary resuscitation
Transfer from an institution with sepsis protocol already underway
Advance directive restricting study protocol

Interventions

Outcome

Primary Outcomes

Secondary Outcomes

Subgroup analysis

Criticisms

Funding

Sources

Authors: