Study finds that two treatment strategies for severe sepsis show similar survival rates

Feb 23, 2010

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 February 24 issue of JAMA.

In the United States, the rate of severe 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.

Alan E. Jones, M.D., of the Carolinas Medical Center, Charlotte, N.C., and colleagues compared outcomes between early resuscitation for patients with severe sepsis or targeting lactate clearance as the marker of adequate vs. targeting ScvO2 measured using a central venous catheter connected to a computerized system. The primary measured outcome was death while in the hospital. The randomized trial included 300 patients with severe sepsis and evidence of hypoperfusion (decreased blood flow to the body tissues) or septic shock who were admitted to the emergency department at 1 of 3 hospitals between January 2007 and January 2009. The patients were randomly assigned to one of the two resuscitation protocols.

The researchers found that 34 patients (23 percent) in the ScvO2 group died while in the hospital compared with 25 (17 percent) in the lactate clearance group, with the observed difference not reaching the predefined threshold difference of 10 percent. There were no differences in treatment-related adverse events between the groups.

"These data support the substitution of lactate measurements in peripheral venous blood as a safe and efficacious alternative to a computerized spectrophotometric catheter in the resuscitation of sepsis," the authors write.

Explore further: Syria hit by flesh-eating maggot disease

More information: JAMA. 2010;303[8]:739-746.

add to favorites email to friend print save as pdf

Related Stories

Surviving sepsis program -- increased compliance gets results

Sep 03, 2009

A 'surviving sepsis' in-hospital project has been shown to improve the care of patients with sepsis. The educational program for early management of patients with septic shock, described in BioMed Central's open access journal ...

Sepsis campaign improving treatment of major killer

Jan 13, 2010

A reduction in hospital mortality from severe sepsis and septic shock was associated with participation in the Surviving Sepsis Campaign performance improvement initiative, according to an article published simultaneously ...

New study aims to stop sepsis in its tracks

Oct 02, 2006

If you've had a heart attack or stroke, paramedics, doctors, and nurses follow standardized protocols for what to do right away, and their efforts improve your odds for a full recovery. That's not the case if you have a body-wide ...

Septic shock: Nitric oxide beneficial after all

Dec 15, 2009

Scientists at VIB and Ghent University in Flanders, Belgium have found an unexpected ally for the treatment of septic shock, the major cause of death in intensive care units. By inducing the release of nitric oxide (NO) gas ...

Recommended for you

Syria hit by flesh-eating maggot disease

51 minutes ago

Three cases of myiasis have been reported near Damascus, marking the first appearance of the flesh-eating maggot disease in Syria, UN health experts said Friday.

Sperm can carry Ebola for 82 days: WHO

2 hours ago

Sperm can carry the Ebola virus for at least 82 days, the World Health Organization said Friday, urging men recovering from the disease to use condoms for three months after the onset of symptoms.

User comments : 0

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.