DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20180315

Comparison of central venous oxygen saturation and serum lactate clearance as predictors of outcome in septic shock patients: a prospective control trial

Gagan Kumar Narula, Ajit Kumar Singh, Anish Adya

Abstract


Background: Sepsis is the leading causes of mortality and morbidity in ICU. Early recognition and intervention ensures speedy recovery and early discharge. It’s possible only if good predicting parameters indicating optimum resuscitation are available. Lactate level reduction and ScvO2 level in the jugular vein can be utilized as predictors.

Methods: In this prospective study after applying exclusion inclusion criteria, 99 patients were selected and randomized into 2 groups. In one group reduction in lactate levels and in other ScVo2 levels were used as a predictor of resuscitation. Therapeutic interventions, Hospital stay, ICU Stay and 28-day mortality were compared in both groups. Statistical analysis was carried out by SPSS software.

Results: On comparison of demographic profile, morbidity, SOFA score and hemodynamic parameters, there was insignificant difference (P >0.05). No significant difference in the number of vasopressors, Average Hospital or ICU Stay (Group A is 10.68±21.46 while Group B is 9.49±17.22) and 28-day mortality rate (in Gp A 60% vs group B 57.1) was observed. Mean crystalloids administered in group A was 4.93±1.11 liters, significantly more than group B i. e. 4.19±1.17 liters. (P<0.05) which was statistically significant.

Conclusions: Although both parameters of resuscitation are used widely and sometimes simultaneously, in this study lactate and ScvO2 both used and compared in a similar set of patients, appeared to be equivocal in term of 28-day mortality, except the volume of crystalloids required was more in ScvO2 Group.


Keywords


Hypotension, Jugular vein saturation, Lactate levels, Mortality, Resuscitation, Sepsis

Full Text:

PDF

References


Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001Jul;29(7):1303-10.

Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003;31(4):1250-6.

Zarbock A, Gomez H, Kellum JA. Sepsis-induced acute kidney injury revisited: pathophysiology, prevention, and future therapies. Curr Opin Crit Care. 2014 Dec;20(6):588-95.

Reinhart K, Rudolph T, Bredle DL, Hannemann L, Cain SM. Comparison of central-venous to mixed-venous oxygen saturation during changes in oxygen supply/demand. Chest. 1989 Jun 30;95(6):1216-21.

Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368-77.

Bakker J, Nijsten MW, Jansen TC. Clinical use of lactate monitoring in critically ill patients. Annals of Intensive Care. 2013 May;3(1):12.

Geroulanos S, Douka ET. Historical perspective of the word sepsis. Intensive Care Med. 2006;32:2077.

Jawad I, Luksic I, Rafnsson SB. Assessing available information on the burden of sepsis: global estimates of incidence, prevalence, and mortality. J Global Health 2012;2(1):010404.

Todi S, Chatterjee S, Sahu S: Epidemiology of severe sepsis in India: an update. Critical Care 2010;14(Suppl 1):P382.

Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013 Feb;39(2):165-228.

Dueck MH, Klimek M, Appenrodt S. Trends but not individual values of central venous oxygen saturation agree with mixed venous oxygen saturation during varying hemodynamic conditions. Anesthesiology. 2005;103:249-257.

Bakker J, Nijsten MW, Jansen TC. Clinical use of lactate monitoring in critically ill patients. Annal Intensive Care. 2013 May;3(1):12.

Aduen J, Bernstein WK, Khastgir T, Miller J, Kerzner R, Bhatiani A et al. The use and clinical importance of a substrate-specific electrode for rapid determination of blood lactate concentrations. JAMA. 1994;272(21):1678-85.

Legrand M, Dupuis C, Simon C, Gayat E, Mateo J, Lukaszewicz AC et al. Association between systemic hemodynamics and septic acute kidney injury in critically ill patients: a retrospective observational study. Crit Care. 2013 Nov 29;17(6):R278.

Jones AE, Shapiro NI, Trzeciak S, Arnold RC, Claremont HA, Kline JA. Lactate Clearance vs Central Venous Oxygen Saturation as Goals of Early Sepsis Therapy. JAMA. 2010;303(8):739-746.

Mikkelsen ME, Miltiades AN, Gaieski DF, Goyal M, Fuchs BD, Shah CV et al. Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock. Crit Care Med. 2009;37:1670-7.

Santana AR, Amorim FF, Menezes BM, Soares FB, Araújo FV, de Souza JL et al. Serum arterial lactate at the time of admission as a predictor of mortality in patients admitted with severe sepsis and septic shock to an ICU. Crit Care. 2013;17(Suppl 4): P47.

Jansen TC, van Bommel J, Schoonderbeek FJ, Sleeswijk Visser SJ, van der Klooster JM, Lima AP, et al. Early lactate-guided therapy in intensive care unit patients. Am J Respir Crit Care Med. 2010 Sep 15;182(6):752-61.

Permpikul C, Noppakaorattanamanee K, Tongyoo S, Ratanarat R, Poompichet A. Dynamics of central venous oxygen saturation and serum lactate during septic shock resuscitation. J Med Assoc Thai. 2013 Feb;96 Suppl 2:S232-7.

Huang DT, Angus DC. Harmonizing international trials of early goal-directed resuscitation for severe sepsis and septic shock: methodology of Process, arise, and promise. Intensive Care Med. 2013;39:1760-1775.