Article Type

Original Study


Objective The aim of this study was to compare the effect of optimizing lactate clearance versus central venous oxygen saturation (ScvO2) as target goals in early sepsis resuscitation. Background Optimal goals for quantitative sepsis resuscitation remain uncertain. It is accepted that hemodynamic targets should include a measure of cardiac preload, such as central venous pressure (CVP), and perfusion pressure, such as mean arterial pressure (MAP). A more controversial issue is the method of determining oxygen delivery. Lactate clearance potentially represents a more accessible method to assess tissue oxygen delivery. Patients and methods We conducted a randomized prospective observational cohort study in the ICU, Menoufia University Hospital. Forty patients with severe sepsis or septic shock were divided into two groups: group V, resuscitated to normalize CVP, MAP, and ScvO2of at least 70%; and group L, resuscitated to normalize CVP, MAP, and lactate clearance of at least 10%. The study was continued until goals were achieved or for up to 72 h, whereas mortality was followed up for 28 days. Results The two groups were matched by demographic and clinical features. As regards lactate clearance in group L, there was a significant difference at hour (h) 6, 12, 24, 48, and 72 compared with h0 (P < 0.05). As regards ScvO2in group V, there was no significant difference compared with h0 at any time. Lactate clearance goal was achieved in 75% of patients in group L, whereas ScvO2goal was achieved in 95% in group V. In group V, 45% of patients died, whereas in group L 30% of patients died, with 15% lower in-hospital mortality (P < 0.05). Lactate clearance was higher in survivors than in nonsurvivors at h6, 12, 24, and 48 (P < 0.05). ScvO2in survivors compared with nonsurvivors showed no significant difference. Conclusion Lactate clearance during resuscitation is a more powerful indicator of resuscitative adequacy. Lactate clearance was the best parameter associated with 28-day mortality. Protocol of lactate clearance-directed therapy should be considered in septic patients, even after the golden hours.