Counterpoint: should lactate clearance be substituted for central venous oxygen saturation as goals of early severe sepsis and septic shock therapy? No.

摘要

In 2001, early goal-directed therapy (EGDT) resulted in a 16% reduction in hospital mortality and, post hoc, a higher lactate clearance in severe sepsis and septic shock. Multiple studies have confirmed the validity and generalizability of EGDT, resulting in its adoption into the Surviving Sepsis Campaign Guidelines. Nguyen et al examined early lactate clearance and found a significant retrospective association with inflammation, apoptosis, coagulation, organ dysfunction, and mortality. Following this rationale, Jones et al modified the EGDT protocol in 2010 using a noninferiority study design and concluded that lactate clearance is equivalent to central venous oxygen saturation (Scvo_2) in the management of individual patients.