Abstract
In this issue of Critical Care, Dutch investigators report that, in a cohort of patients with sepsis/septic shock admitted to three different intensive care units (ICUs), low central venous oxygen saturation (ScvO2) was uncommon at the time of ICU admission, and hospital mortality was <30%. Their findings, taken together with those of recent reports from Australia and New Zealand (ANZ), raise serious concerns about the utility of early goal directed therapy (EGDT) outside the context of the original trial. Despite inclusion of EGDT into the Surviving Sepsis Guidelines, in response to growing uncertainty, ANZ and US investigators will soon begin randomization of patients into two large multicentre trials comparing EGDT to standard therapy. Until such studies are completed, basing international treatment guidelines on a single centre study performed in what may turn out to be a highly atypical environment would seem premature.
Highlights
Many physicians believe that global hypoxia secondary to inadequate oxygen delivery (DO2) is responsible for organ failure during severe sepsis
The issue of DO2 and oxygen consumption in sepsis is highlighted in the paper by van Beest and colleagues [1] in this edition of Critical Care. These authors have focused on central venous oxygen saturation (ScvO2) as a marker of systemic oxygenation. They have done this partly in response to the following fashionable, but yet untested, concepts: first, ScvO2 is a reliable marker of global tissue hypoxia; second, increasing ScvO2 by early goal directed therapy (EGDT) [2] improves outcome; and third, we should follow the Surviving Sepsis Campaign Guidelines [3] by pursuing a SvcO2 >70% in septic patients
The Dutch patients were different to those in the EGDT study in several important respects: only half were admitted from the emergency department, and many must have received intravenous fluid prior to their intensive care unit (ICU) admission
Summary
Many physicians believe that global hypoxia secondary to inadequate oxygen delivery (DO2) is responsible for organ failure during severe sepsis. They have done this partly in response to the following fashionable, but yet untested, concepts: first, ScvO2 is a reliable marker of global tissue hypoxia; second, increasing ScvO2 by early goal directed therapy (EGDT) [2] improves outcome; and third, we should follow the Surviving Sepsis Campaign Guidelines [3] by pursuing a SvcO2 >70% in septic patients. The Dutch patients were different to those in the EGDT study in several important respects: only half were admitted from the emergency department, and many must have received intravenous fluid prior to their intensive care unit (ICU) admission.
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