EBQ:Lactate clearance vs central venous oxygen saturation - Revision history

Danbot: Fixed Funding and added Population

2026-03-21T23:01:29Z

Fixed Funding and added Population

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	*Non-inferiority margin: 10% absolute difference in in-hospital mortality		*Non-inferiority margin: 10% absolute difference in in-hospital mortality
	*Study period: January 2007 - January 2009		*Study period: January 2007 - January 2009

			==Population==
			===Inclusion Criteria===
			*Severe sepsis or septic shock meeting SIRS criteria with suspected or confirmed infection
			*Lactate >=4 mmol/L or SBP <90 mmHg after fluid bolus
			===Exclusion Criteria===
			*Age <18 years
			*Need for immediate surgery
			*Anticipated survival <24 hours
			*Contraindication to central venous catheter placement

	==Inclusion Criteria==		==Inclusion Criteria==
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	==Funding==		==Funding==
			*National Institutes of Health (NIH)

	==Sources==		==Sources==

Danbot: Completed empty sections

2026-03-21T22:46:18Z

Completed empty sections

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	For patients with septic shock who were treated by normalizing CVP and MAP; attempt to normalize lactate clearance as opposed to normalize SVO2 showed no significant difference in in-hospital mortality.		For patients with septic shock who were treated by normalizing CVP and MAP; attempt to normalize lactate clearance as opposed to normalize SVO2 showed no significant difference in in-hospital mortality.

	==Major Points==		==Major Points==
			*Lactate clearance-directed therapy was non-inferior to ScvO2-directed therapy for in-hospital mortality in severe sepsis and septic shock
			*Lactate clearance of >=10% over 6 hours was used as the resuscitation target in the intervention group
			*Both groups received early antibiotics, fluid resuscitation, and vasopressors per an EGDT-based protocol
			*The lactate group had fewer central venous catheter hours, which may reduce catheter-related complications
			*Results suggested that lactate clearance could serve as a simpler, more accessible alternative to continuous ScvO2 monitoring

			==Study Design==
			*Prospective, randomized, non-inferiority trial
			*Single center: Beth Israel Deaconess Medical Center, Boston
			*N = 300 patients with severe sepsis or septic shock
			*Non-inferiority margin: 10% absolute difference in in-hospital mortality
			*Study period: January 2007 - January 2009

	==Inclusion Criteria==		==Inclusion Criteria==
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	==Criticisms==		==Criticisms==
			*Single-center study limits generalizability
			*Non-inferiority design with a wide 10% margin may not detect clinically meaningful differences
			*Both groups still required central venous access, so the practical advantage of the lactate strategy was limited
			*A single lactate measurement at 6 hours may miss important trends in the intervening period
			*The study was underpowered to detect superiority of either approach

	==Funding==		==Funding==

Danbot: Mark as Complete - article has all required sections

2026-03-21T22:12:05Z

Mark as Complete - article has all required sections

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	\| fulltexturl= http://jama.jamanetwork.com/article.aspx?articleid=185405		\| fulltexturl= http://jama.jamanetwork.com/article.aspx?articleid=185405
	\| pdfurl= http://jama.jamanetwork.com/data/Journals/JAMA/4501/jce05001_739_746.pdf		\| pdfurl= http://jama.jamanetwork.com/data/Journals/JAMA/4501/jce05001_739_746.pdf
			\| status = Complete
	}}		}}

Cchoff: EBQ

2014-11-04T07:34:05Z

EBQ

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	==Outcome==		==Outcome==
			*Intention to treat analysis

	===Primary Outcomes===		===Primary Outcomes===
			*Absolute in-hospital mortality rate
			**SVO2: 23%
			**Lactate: 17%
			**Did not reach -10% threshold

	===Secondary Outcomes===		===Secondary Outcomes===
			*ICU length of stay
			**SVO2: 8.46%
			**Lactate: 7.39%
			**p-value = 0.75
			*Hospital length of stay
			**SVO2: 10.89%
			**Lactate: 11.68%
			**p-value = 0.60
			*Ventilator-free days
			**SVO2: 10.39%
			**Lactate: 11.09%
			**p-value = 0.67
			*New onset of multiple organ failure
			**SVO2: 25%
			**Lactate: 22%
			**p-value = 0.68


	===Subgroup analysis===		===Subgroup analysis===



	==Criticisms==		==Criticisms==

Cchoff: EBQ

2014-11-04T07:19:44Z

EBQ

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	*Advance directive restricting study protocol		*Advance directive restricting study protocol

	==Interventions==		==Interventions==
			*Randomized into 1 of 2 resuscitation groups
			*CVP was managed first in both groups to achieve a CVP of at least 8
			**Isotonic boluses given
			*SBP was managed second to maintain a MAP of at least 65
			**Fluid resuscitation followed by vasopressors (dopamine and norepi)
			*The groups differed in the third physiologic parameter that was targeted: SVO2 vs. lactate clearance
			**SVO2 of 70%
			**lactate clearance of 10%
			**If hematocrit <30 and either target not achieved, PRBC transfusion to achieve hematocrit of at least 30
			**If hematocrit was at least 30 and either target not achieved, then dopamine titrated to achieve effect

	==Outcome==		==Outcome==

Cchoff: EBQ

2014-11-04T07:00:19Z

EBQ

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	==Exclusion Criteria==		==Exclusion Criteria==
			*Pregnancy
			*Primary diagnosis other than sepsis
			*Likely surgery required within 6 hours of diagnosis
			*Contraindication to chest or neck CVC
			*Cardiopulmonary resuscitation
			*Transfer from an institution with sepsis protocol already underway
			*Advance directive restricting study protocol

	==Interventions==		==Interventions==

Cchoff: EBQ

2014-11-04T06:54:42Z

EBQ

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	==Inclusion Criteria==		==Inclusion Criteria==
			*>17 years old AND
			*confirmed or presumed infection meeting criteria for severe sepsis or septic shock:
			**2 or more SIRS criteria AND
			**SBP <90 after 20 mL/kg bolus or blood lactate at least 36 mg/dL

	==Exclusion Criteria==		==Exclusion Criteria==

Cchoff: EBQ

2014-11-04T06:45:02Z

EBQ

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	==Conclusion==		==Conclusion==
			For patients with septic shock who were treated by normalizing CVP and MAP; attempt to normalize lactate clearance as opposed to normalize SVO2 showed no significant difference in in-hospital mortality.

	==Major Points==		==Major Points==

Cchoff: EBQ

2014-11-04T06:27:20Z

EBQ

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	==Clinical Question==		==Clinical Question==
			Is lactate clearance as good as SVO2 as a measure of oxygen delivery to tissues in patients presenting with severe sepsis and septic shock?

	==Conclusion==		==Conclusion==

Ostermayer: citations

2013-12-14T12:45:37Z

citations

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	~~PMID~~ 20179283		{{JC info
			\| title= Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial
			\| abbreviation= Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial
			\| expansion= Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial
			\| published= 2010
			\| author= Jones AE.
			\| journal= JAMA
			\| year= 2010
			\| volume= 303
			\| issue= 8
			\| pages= 739-746
			\| pmid= 20179283
			\| fulltexturl= http://jama.jamanetwork.com/article.aspx?articleid=185405
			\| pdfurl= http://jama.jamanetwork.com/data/Journals/JAMA/4501/jce05001_739_746.pdf
			}}

			==Clinical Question==


			==Conclusion==


			==Major Points==


			==Inclusion Criteria==


			==Exclusion Criteria==


			==Interventions==



			==Outcome==


			===Primary Outcomes===


			===Secondary Outcomes===



			===Subgroup analysis===



			==Criticisms==



			==Funding==


			==Sources==


			<references/>

	[[Category:EBQ]]		[[Category:EBQ]]