A comparison of two strategies for treating severe sepsis or septic shock finds that using lactate levels measured in blood samples showed a similar short-term survival rate compared to a treatment regimen using central venous oxygen saturation measured using a specialized catheter, according to a study in the Feb. 24 issue of JAMA.
In the United States, the rate of severe sepsis hospitalizations has doubled during the last decade, with estimates indicating that at least 750,000 persons are affected annually. Approximately 500,000 patients with severe sepsis in the United States are initially treated in emergency departments every year. Among suggested treatment strategies is the controversial issue of the method of determining tissue oxygen delivery, according to background information in the article.
“Citing a single-center study, the Surviving Sepsis Campaign guidelines recommend the use of central venous oxygen saturation (ScvO2) or mixed venous oxygen saturation to assess the balance of tissue oxygen delivery and consumption; however, since its publication in 2001 a substantial amount of controversy about this single-center study has been generated in the scientific community. Additionally, 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. In contrast, lactate clearance, derived from calculating the change in lactate concentration from 2 blood specimens drawn at different times, potentially represents a more accessible method to assess tissue oxygen delivery,” the authors write.
