Two Treatment Strategies for Severe Sepsis Show Similar Survival Rates

Treating severe sepsis using measure lactate levels showed a similar short-term survival rate as a treatment regimen using targeted central venous oxygen saturation (ScvO2), according to a new study.

Researchers at the Carolinas Medical Center (Charlotte, NC, USA) conducted a randomized trial that compared outcomes between early resuscitation in 300 patients with severe sepsis or septic shock. The researchers compared the targeting of lactate clearance as the marker of adequate oxygen delivery to the targeting of ScvO2, as measured using a central venous catheter connected to a computerized system. The primary measured outcome was death while in the hospital. All participating patients presented with severe sepsis and evidence of hypoperfusion (decreased blood flow to the body tissues) or with septic shock, and were admitted to the emergency department (ED) between January 2007 and January 2009.

The researchers found that 34 patients (23%) in the ScvO2 group died while in the hospital compared with 25 (17%) in the lactate clearance group, with the observed difference not reaching the predefined threshold difference of 10%. There were no differences in treatment-related adverse events between the groups. The study was published in the February 24, 2010 issue of the Journal of the American Medical Association (JAMA).

"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,” concluded lead author Alan Jones, M.D, and colleagues. "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.”

In an accompanying editorial, Roger Lewis, M.D., Ph.D., of the Harbor-UCLA Medical Center (Torrance, CA, USA) commented on the findings, "… the study by Jones et al is an important first step to identifying less burdensome approaches to the initial management of critically ill patients with severe sepsis and septic shock. Substantial further progress most likely will depend on appropriately designed, rigorously conducted clinical trials (requiring novel strategies, such as adaptive design) that can efficiently and practically address the complicated questions inherent in identifying the optimal and least burdensome combination of resuscitation targets.”

Related Links:
Carolinas Medical Center
Harbor-UCLA Medical Center