Counterpoint: Should Lactate Clearance Be Substituted for Central Venous Oxygen Saturation as Goals of Early Severe Sepsis and Septic Shock Therapy? No

Comprehensive Interpretation of Central Venous Oxygen Saturation and Blood Lactate Levels During Resuscitation of Patients With Severe Sepsis and Septic Shock in the Emergency Department

“…Therefore, the complementary interpretation of lactate and Scvo 2 might lead to more accurate predictions of underlying pathophysiologic conditions and oxygen delivery than information from a single index. For example, in our study, Group 1 patients might represent relatively normal or compensated metabolic status, Group 2 oxygen deficit status, Group 3 microcirculatory dysfunction status, and Group 4 oxygen debt status (6,23,35). The combined use of biomarkers may be a good predictor of early outcomes and a potential indicator for additional therapeutic interventions.…”

“…There are, however, potential pitfalls in the interpretation of lactate levels because normal lactate levels are common in patients with septic shock, despite considerable risk of mortality, and lactate kinetics can be affected by many factors (5,23,(35)(36)(37). Therefore, the complementary interpretation of lactate and Scvo 2 might lead to more accurate predictions of underlying pathophysiologic conditions and oxygen delivery than information from a single index.…”

Central Venous Oxygen Saturation Under Non-Protocolized Resuscitation Is Not Related to Survival in Severe Sepsis or Septic Shock

“…Results from multicenter ProCESS trials may clarify the role of ScvO 2 in protocolized treatment in the future. Finally, a recent study demonstrated that high postresuscitation ScvO 2 without achieving the goal of lactate clearance (Q10%) was associated with higher mortality than those that achieved lactate clearance but with low postresuscitation ScvO 2 (29). So far, there is still considerable debate about the role of lactate clearance or ScvO 2 in early resuscitation (5,30).…”

Propranolol et lactatémie durant un choc hypovolémique non septique : à propos d’une observation

“…Les mécanismes responsables de la formation accrue de lactate et la physiopathologie des chocs ont été largement documentés dans la littérature [6][7][8][9]. D'autre part, l'absence d'hyperlactatémie, parfois observée dans le choc septique [10], n'est classiquement pas observée dans le choc causé par une déshydratation sévère ou une hémorragie importante [11]. Nous rapportons le cas d'une enfant de 9 mois ayant développé un choc hypovolémique causé par une déshydratation sévère chez qui, de manière plutôt inhabituelle pour ce type de choc, aucune hyperlactatémie n'a été observée.…”