Benefit of achieving lactate clearance versus central venous oxygen saturation target as microcirculation end point resuscitation in severe sepsis and septic shock

Introduction

In severe sepsis and septic shock patients, lactate clearance >10% and central venous oxygen saturation (ScvO₂) >70% are accepted parameters of tissue oxygenation adequacy. There is controversy of which parameters better associate with early mortality, and thus should be implemented as the microcirculation end point resuscitation [1–3]. This study was aimed to address the association of achieving either one or two targets of microcirculatory end point resuscitation and early mortality in severe sepsis and septic shock patients.

Methods

A retrospective cohort study was conducted in severe sepsis and septic shock patients (aged 18 years and older) hospitalized in the ICU, Cipto Mangunkusumo Hospital, Indonesia. Patients' early outcomes were observed during first 120 hours of hospitalization. Cox's regression analysis was used to analyse risk of early mortality in subject groups achieving lactate clearance target only, ScvO₂ target only, both targets, and not achieving any target in 6 hours after onset of resuscitation.

Results

Subjects consisted of 268 patients. Early mortality developed in 70 subjects. Fifty-four subjects achieved lactate clearance target only, 16 achieved ScvO₂ target only, 138 achieved both targets, 60 did not achieve any target. Subjects who achieved both targets had a significant lowest early mortality risk (P = 0.104 compared with subjects achieved lactate clearance target only and P = 0.000 compared with remaining subject groups) (Figure 1). In subgroup analysis of subjects who achieved lactate clearance or ScvO₂ target only, failure to achieve lactate clearance target associated with higher early mortality risk (hazard ratio 5.92; 95% CI 2.18 to 16.01).

Figure 1

Survival analysis of groups based on target achievement.

Conclusion

Achieving both lactate clearance and ScvO₂ targets in 6 hours after onset of resuscitation associates with lowest early mortality risk in severe sepsis and septic shock patients. Patients who achieve lactate clearance target only have a significant lower early mortality risk compared with those who achieve ScvO₂ target only.