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Editorials |

Point: Should Lactate Clearance Be Substituted for Central Venous Oxygen Saturation as Goals of Early Severe Sepsis and Septic Shock Therapy? YesLactate Clearance as a Goal for Septic Shock

Alan E. Jones, MD
Author and Funding Information

From the Department of Emergency Medicine, University of Mississippi Medical Center.

Correspondence to: Alan E. Jones, MD, Department of Emergency Medicine, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216; e-mail: aejones@umc.edu

Financial/nonfinancial disclosures: The author has reported to CHEST the following conflicts of interest: Dr Jones has received funding from the National Institutes of Health to study lactate clearance in sepsis resuscitation. Dr Jones has never been assigned patents, nor has he received patent royalties, honoraria, consulting fees, or other monetary or nonmonetary payments at any time related to the use of lactate or lactate clearance.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Financial/nonfinancial disclosures: The author has reported to CHEST the following conflicts of interest: Dr Jones has received funding from the National Institutes of Health to study lactate clearance in sepsis resuscitation. Dr Jones has never been assigned patents, nor has he received patent royalties, honoraria, consulting fees, or other monetary or nonmonetary payments at any time related to the use of lactate or lactate clearance.

Financial/nonfinancial disclosures: The author has reported to CHEST the following conflicts of interest: Dr Jones has received funding from the National Institutes of Health to study lactate clearance in sepsis resuscitation. Dr Jones has never been assigned patents, nor has he received patent royalties, honoraria, consulting fees, or other monetary or nonmonetary payments at any time related to the use of lactate or lactate clearance.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Chest. 2011;140(6):1406-1408. doi:10.1378/chest.11-2560
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Extract

Quantitative resuscitation in critically ill patients consists of structured cardiovascular interventions, such as intravascular volume expansion and vasoactive agent support, to achieve explicit predefined physiologic parameters or goals. The concept of quantitative resuscitation (also referred to as hemodynamic optimization or goal-directed therapy) as a treatment strategy to improve clinical outcome was first reported in high-risk surgery patients.1 A recent meta-analysis of randomized clinical trials that compared quantitative resuscitation with standard resuscitation in septic shock found that when therapy was initiated within 24 h of the onset of sepsis (six trials, 740 patients), resuscitation targeting specific physiologic end points improved mortality compared with standard resuscitation (39% vs 57%: OR, 0.50; 95% CI, 0.37-0.69).2 In contrast, when therapy was initiated > 24 h after the onset of sepsis (three trials, 261 patients), resuscitation targeting specific physiologic end points did not improve mortality (64% vs 58% for standard resuscitation; OR, 1.16; 95% CI, 0.60-2.22). Although the data supporting the use of early quantitative resuscitation are robust, the optimal end points or goals of such therapy are controversial.

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