Lactate Clearance Measures Efficacy of Goal-Directed Therapy in Sepsis

Goal-directed resuscitation for severe sepsis focuses on three targets: (1) fluid resuscitation to a central venous pressure of 8–12 mm Hg, (2) pressure support to a mean arterial pressure of at least 65 mm Hg, and (3) adequate oxygen delivery (via blood transfusion, dobutamine infusion, or both) to central venous oxygen saturation (ScvO₂) of at least 70%. Measurement of ScvO₂, however, requires a special catheter. These authors tested the hypothesis that use of lactate clearance >10% is not inferior to use of ScvO₂ ≥70% for assessing the adequacy of oxygen delivery.

In a prospective study conducted at the emergency departments of three U.S. medical centers, 300 patients with severe sepsis and septic shock were randomized to resuscitation to…