Lactate Clearance And Central Venous Oxygen Saturation In The Patients With Severe Sepsis Or Septic Shock

ObjectiveTo evaluate the clinical utility of the lactate clearance and central venous oxygen saturation (ScVO₂) as indicators of outcome in severe sepsis and septic shock..MethedsWe randomly assigned patients who arrived at ICU with severe sepsis or septic shock in control group, lactate clearance group and central venous oxygen saturation (ScVO₂) group. All patients were treated with fluid resuscitation. The goal of fluid resuscitation included the following: CVP targeting 8-12mmHg; MAP targeting＞65mmHg; heart rate targeting＜110/min and urine volume targeting＞0.5ml /kg.h. For control group, the goal of fluid resuscitation was obtained for 72 hours. For central venous oxygen saturation (ScVO₂) group, after reached the goal of fluid resuscitation, if central venous oxygen saturation (ScVO₂) was＜70%, we treated patients with vasoactive drug, and erythrocyte suspension in order to make central venous oxygen saturation (ScVO₂) targeting≥70% and remain the level for 72 hours. For lactate clearance group, after reached the goal of fluid resuscitation, if lactate clearance was＜10%, we treated patients with vasoactive drug, and erythrocyte suspension in order to make lactate clearance targeting≥10% and remain the level for 72 hours. End points included the following: heart rate, Bp, break rate, CVP, urine volume, ScVO₂, lactate clearance, pulmonary edema, acute cardiac insufficiency, acute renal inadequacy, MODS, mortality rate at 7 days, mortality rate at 28 days. End points were obtained and compared among the three groups.ResultLactate clearance group and central venous oxygen saturation (ScVO₂) group had lower rate of MODS and mortality rate compared with control group. Lactate clearance group had lower mortality rate at 7 day compared with control group and central venous oxygen saturation (ScVO₂) group.ConclusionLactate clearance and ScVO₂ provides significant benefits and is associated with decreased mortality rate in patients with severe sepsis or septic shock.