A comparison of two strategies for treating severe sepsis or septic shock finds that using lactate levels measured in blood samples showed a similar short-term survival rate compared to a treatment regimen using central venous oxygen saturation measured using a specialized catheter.
“Citing a single-centre study, the Surviving Sepsis Campaign guidelines recommend the use of central venous oxygen saturation (ScvO2) or mixed venous oxygen saturation”, the authors write. “However, since its publication a substantial amount of controversy about this single-centre study has been generated. Additionally, recently published practice surveys have indicated that the time, expertise, and specialized equipment required to measure ScvO2 collectively pose a major barrier to the implementation of protocol-driven quantitative resuscitation programs.”
The authors continue: “In contrast, lactate clearance, derived from calculating the change in lactate concentration from two blood specimens drawn at different times, potentially represents a more accessible method to assess tissue oxygen delivery.”
The researchers compared outcomes between early resuscitation for patients with severe sepsis or septic shock targeting lactate clearance as the marker of adequate oxygen delivery versus targeting ScvO2 measured using a central venous catheter connected to a computerized system. The primary measured outcome was death while in the hospital. The randomized trial included 300 patients with severe sepsis and evidence of hypoperfusion – that is decreased blood flow to the body tissues - or septic shock who were admitted to the emergency department at one of three hospitals between 2007 and 2009. The patients were randomly assigned to one of the two resuscitation protocols.
The researchers found that 34 patients (23 percent) in the ScvO2 group died while in the hospital compared with 25 (17 percent) in the lactate clearance group, with the observed difference not reaching the predefined threshold difference of ten percent. There were no differences in treatment-related adverse events between the groups.
“These data support the substitution of lactate measurements in peripheral venous blood as a safe and efficacious alternative to a computerized spectrophotometric catheter in the resuscitation of sepsis,” the authors write.
MEDICA.de; Source: American Medical Association (AMA)