Point: Should Lactate Clearance Be Substituted for Central Venous Oxygen Saturation as Goals of Early Severe Sepsis and Septic Shock Therapy? Yes

Abstract

In 2001, early goal-directed therapy (EGDT) resulted in a 16% reduction in hospital mortality and, post hoc, a higher lactate clearance in severe sepsis and septic shock.1 Multiple studies have confirmed the validity and generalizability of EGDT, resulting in its adoption into the Surviving Sepsis Campaign Guidelines.2,3 Nguyen et al4,5 examined early lactate clearance and found a significant retrospective association with inflammation, apoptosis, coagulation, organ dysfunction, and mortality. Following this rationale, Jones et al6 modified the EGDT protocol in 2010 using a noninferiority study design and concluded that lactate clearance is equivalent to central venous oxygen saturation (Scvo2) in the management of individual patients. Before applying the findings of Jones et al6 to one’s next patient, compare the baseline characteristics, early hemodynamic patterns, and therapeutic interventions between those of Jones et al6 and the EGDT study.1 Further, review the complexities of lactate kinetics and the weaknesses of a noninferiority study design.7 Based on these facts, it is clear that lactate clearance and Scvo2 are not equivalent, but complementary goals for the individual patient.