Lactate Clearance vs Central Venous Oxygen Saturation as Goals of Early Sepsis Therapy: A Randomized Clinical Trial.
Early goal-directed fluid resuscitation is the cornerstone of therapy for septic shock, but the optimal target for goal-directed resuscitation has not been well studied. The investigators sought to determine whether lactate clearance and central venous oxygen saturation (ScvO2) are equally effective as guides for early sepsis resuscitation. A cohort of 300 patients presenting to the emergency department with septic shock were randomly assigned to resuscitation guided either by normalization of ScvO2 (above 70%) or lactate clearance (at least 10% from baseline or remaining below 2 mmol/L), in addition to standard goals for mean arterial and central venous pressure. The 2 groups did not differ in the treatments that were administered during the 6 hours of goal-directed resuscitation or during the first 72 hours of hospitalization. Death occurred in 23% of patients managed with the ScvO2 protocol and in 17% of patients managed with the lactate clearance protocol, with no difference in adverse events between the 2 groups. The investigators concluded that early goal-directed fluid resuscitation of patients with septic shock can be safely guided by either ScvO2 or lactate clearance.
A high ScvO2 cannot always be considered normal because dysfunctional tissue oxygen extraction (as in sepsis) may lead to increased ScvO2and thus falsely reassure the clinician about the health of the patient