Screen Shot 2018-08-03 at 15.15.05.png

Lactate clearance vs. Scv02 for Early Goal-Directed Therapy

  • Included 300 patients presenting to the ED with severe sepsis or septic shock
  • Randomized patients to either central venous oxygen saturation (Scv02 > 70%) or lactate clearance (>10% clearance).
  • This was the third goal of therapy following maximization of central venous pressure (CVP > 8 mmHg) and mean arterial pressure (MAP > 65 mmHg)
    • Lactate clearance = 100 x (lactate initial – lactate delayed) / lactate initial
  • Lactate clearance was initially measured 2 hours after initial lactate, and then every hour thereafter.
  • Lactate levels less than 2 mmol/L were considered to be at goal
  • As with Scv02, if lactate clearance was < 10%, pRBCs and dobutamine were given (based on Rivers 2001 criteria)
  • Primary endpoint (hospital mortality rate) was non-inferior between Scv02 and lactate clearance (23% vs. 17%, Cl difference of -3% to +15%)
  • The median lactate clearance at 2 hours was 40%
  • Baseline lactate levels were much lower than those seen in the original Rivers 2001 early-goal directed therapy trial (7 mmol/L vs. 4 mmol/L)
  • Only 10% of patients required pRBC transfusion or dobutamine; thus, the difference in protocol only applied to a minority of study patients


In ED patients with severe sepsis or septic shock, early goal-directed therapy with lactate clearance is non-inferior to central venous oxygen saturation for hospital mortality.

See the paper here


Powered by WordPress.com.

Up ↑

You have successfully subscribed to the newsletter

There was an error while trying to send your request. Please try again.

Critical Care Northampton will use the information you provide on this form to be in touch with you and to provide updates and marketing.
%d bloggers like this: