Prognostic Value and Agreement of Achieving Lactate Clearance or Central Venous Oxygen Saturation Goals During Early Sepsis Resuscitation
Academic Emergency Medicine,

Puskarich MA et al. – No agreement was found between Lactate clearance (LC) and central venous oxygen saturation (ScvO2) goal achievement in early sepsis resuscitation. Achievement of a ScvO2≥70% without LC≥10% was more strongly associated with mortality than achievement of LC≥10% with failure to achieve ScvO2≥70%.

Methods
  • This was a preplanned analysis of a multicenter ED randomized controlled trial of early sepsis resuscitation targeting three variables: central venous pressure, mean arterial pressure, and either ScvO2 or LC.
  • Inclusion criteria included suspected infection, two or more systemic inflammation criteria, and either systolic blood pressure of <90mmHg after intravenous fluid bolus or lactate level of >4mmol/L.
  • Both ScvO2 and LC were measured simultaneously.
  • The ScvO2 goal was defined as ≥70%.
  • Lactate was measured at enrollment and every 2hours until the goal was reached or up to 6hours.
  • LC goal was defined as a decrease of ≥10% from initial measurement.
  • The primary outcome was in-hospital mortality.

Results
  • A total of 203 subjects were included, with an overall mortality of 19.7%.
  • Achievement of the ScvO2 goal only was associated with a mortality rate of 41% (9/22), while achievement of the LC goal only was associated with a mortality rate of 8% (2/25; proportion difference=33%; 95% confidence interval [CI]=9% to 55%).
  • No agreement was found between goal achievement (κ=-0.02), and exact test for matched pairs demonstrated no significant difference between discordant pairs (p=0.78).

Please login or register to follow this author.
Are you sure you want to Unfollow this Author?
► Click here to access PubMed, Publisher and related articles...
<< Previous Article | Next Article >>

Your Unread Messages in Emergency Medicine

See All >> Messages include industry-sponsored communications and special communications from MDLinx

Most Popular Emergency Medicine Articles

1 The NOTA study (non operative treatment for acute appendicitis): Prospective study on the efficacy and safety of antibiotics (amoxicillin and clavulanic acid) for treating patients with right lower quadrant abdominal pain and long-term follow-up of conservatively treated suspected appendicitis Annals of Surgery, June 18, 2014    Clinical Article

2 Prednisone for emergency department low back pain: A randomized controlled trial The Journal of Emergency Medicine, May 29, 2014    Clinical Article

3 Altitude sickness in climbers and efficacy of NSAIDs trial (ASCENT): Randomized, controlled trial of ibuprofen versus placebo for prevention of altitude illness The Journal of Emergency Medicine, June 27, 2014    Clinical Article

4 Intravenous lidocaine for the emergency department treatment of acute radicular low back pain, a randomized controlled trial The Journal of Emergency Medicine, May 28, 2014    Clinical Article

5 Antibiotic prophylaxis for ED patients with simple hand lacerations: a feasibility randomized controlled trial The American Journal of Emergency Medicine, May 19, 2014    Clinical Article

6 Are echocardiography, telemetry, ambulatory electrocardiography monitoring, and cardiac enzymes in emergency department patients presenting with syncope useful tests? a preliminary investigation The Journal of Emergency Medicine, June 12, 2014    Clinical Article

7 Injectable lidocaine provides similar analgesia compared to transdermal lidocaine/tetracaine patch for the incision and drainage of skin abscesses: a randomized, controlled trial The Journal of Emergency Medicine, June 4, 2014    Clinical Article

8 Hypertonic saline with furosemide for the treatment of acute congestive heart failure: A systematic review and meta-analysis International Journal of Cardiology, April 4, 2014    Evidence Based Medicine    Review Article    Clinical Article

9 Prednisone for emergency department low back pain: a randomized controlled trial The Journal of Emergency Medicine, April 17, 2014    Clinical Article

10 Emergency medical services management of ST-segment elevation myocardial infarction in the United States—a report from the American Heart Association Mission: Lifeline Program The American Journal of Emergency Medicine, June 2, 2014    Review Article

11 Injectable lidocaine provides similar analgesia compared to transdermal lidocaine/tetracaine patch for the incision and drainage of skin abscesses: a randomized, controlled trial The Journal of Emergency Medicine, June 10, 2014    Clinical Article

12 Detecting cognitive impairment after concussion: sensitivity of change from baseline and normative data methods using the CogSport/Axon cognitive test battery Archives of Clinical Neuropsychology, June 5, 2014    Clinical Article

13 Utility of serum pancreatic enzyme levels in diagnosing blunt trauma to the pancreas: A prospective study with systematic review Injury, June 24, 2014    Evidence Based Medicine    Review Article

14 Results of a multicenter, double-blind, randomized, parallel-group, placebo-controlled, single-dose study comparing the fixed combination of acetaminophen, acetylsalicylic acid, and caffeine with ibuprofen for acute treatment of patients with severe migraine Cephalalgia, May 1, 2014    Clinical Article

15 Night shifts in emergency medicine: the American board of emergency medicine longitudinal study of emergency physicians The Journal of Emergency Medicine, June 13, 2014    Clinical Article

16 Prednisone for emergency department low back pain: A randomized controlled trial The Journal of Emergency Medicine, June 2, 2014    Clinical Article

17 Despite expert recommendations, second-generation antipsychotics are not often prescribed in the emergency department The Journal of Emergency Medicine, June 10, 2014    Clinical Article

18 Geriatric-specific triage criteria are more sensitive than standard adult criteria in identifying need for trauma center care in injured older adults Annals of Emergency Medicine, June 11, 2014    Clinical Article

19 Use of emergency medical services expedites in-hospital care processes in patients presenting with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention Cardiovascular Revascularization Medicine, June 23, 2014    Clinical Article

20 A review of treatment strategies for hydrofluoric acid burns: Current status and future prospects Burns, June 20, 2014    Review Article

Indexed Journals in Emergency Medicine: Journal of Emergency Medicine, Annals of Emergency Medicine, Injurymore

Register now to view all the MDLinx contents (FREE)!

  • Stay current on the latest literature, research and clinical news
  • Get special communications and offers from MDLinx and our sponsors
  • Receive invitations to paid market research
View Samples and Register

Connect with us, stay current.

Receive the latest mecial news
updates for free via email

Sign up!

Subscribe to our free RSS feeds:

Get the latest news in your specialty automatically added to your newsreader or your personal My Yahoo!, Google, My MSN or My AOL page. Learn More

Close