Science News
from research organizations

Two treatment strategies for severe sepsis show similar survival rates

Date:
February 23, 2010
Source:
JAMA and Archives Journals
Summary:
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 new study.
Share:
FULL STORY

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 sepsis 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 septic shock targeting lactate clearance as the marker of adequate oxygen delivery 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.

Editorial: Disassembling Goal-Directed Therapy for Sepsis -- A First Step

In an accompanying editorial, Roger J. Lewis, M.D., Ph.D., of the Harbor-UCLA Medical Center, Los Angeles, comments on the findings of this study.

" … the study by Jones et at is an important first step to identifying less burdensome approaches to the initial management of critically ill patients with severe sepsis and septic shock. Substantial further progress most likely will depend on appropriately designed, rigorously conducted clinical trials (requiring novel strategies, such as adaptive design) that can efficiently and practically address the complicated questions inherent in identifying the optimal and least burdensome combination of resuscitation targets."


Story Source:

Materials provided by JAMA and Archives Journals. Note: Content may be edited for style and length.


Journal References:

  1. Alan E. Jones; Nathan I. Shapiro; Stephen Trzeciak; Ryan C. Arnold; Heather A. Claremont; Jeffrey A. Kline; for the Emergency Medicine Shock Research Network (EMShockNet) Investigators. Lactate Clearance vs Central Venous Oxygen Saturation as Goals of Early Sepsis Therapy: A Randomized Clinical Trial. JAMA, 2010; 303 (8): 739-746 [link]
  2. Roger J. Lewis. Disassembling Goal-Directed Therapy for Sepsis: A First Step. JAMA, 2010; 303 (8): 777-779 [link]

Cite This Page:

JAMA and Archives Journals. "Two treatment strategies for severe sepsis show similar survival rates." ScienceDaily. ScienceDaily, 23 February 2010. <www.sciencedaily.com/releases/2010/02/100223161827.htm>.
JAMA and Archives Journals. (2010, February 23). Two treatment strategies for severe sepsis show similar survival rates. ScienceDaily. Retrieved May 23, 2017 from www.sciencedaily.com/releases/2010/02/100223161827.htm
JAMA and Archives Journals. "Two treatment strategies for severe sepsis show similar survival rates." ScienceDaily. www.sciencedaily.com/releases/2010/02/100223161827.htm (accessed May 23, 2017).

RELATED STORIES