Lactate Clearance vs Central Venous Oxygen Saturation as Goals of Early Sepsis Therapy&lt;subtitle&gt;A Randomized Clinical Trial&lt;/subtitle&gt;

Jones, Alan E.; Shapiro, Nathan I.; Trzeciak, Stephen; Arnold, Ryan; Claremont, Heather A.; Kline, Jeffrey A.

doi:10.1001/jama.2010.158

Cited by 917 publications

(639 citation statements)

References 31 publications

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“…Reducing the time to diagnosis of severe sepsis is thought to be a critical component of reducing mortality from sepsis-related multiple organ dysfunction [50]. As oncological patients with sepsis are logically not different from other septic patients, the panel recommends an early diagnosis of sepsis by following the three main steps: Table 3 Infection probability score a (IPS) [51].…”

Section: Statements About Monitoring and Diagnosis Of Sepsismentioning

confidence: 99%

Sepsis in head and neck cancer patients treated with chemotherapy and radiation: Literature review and consensus

Mirabile

Numico²,

Russi

et al. 2015

Critical Reviews in Oncology/Hematology

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The reporting of infection/sepsis in chemo/radiation-treated head and neck cancer patients is sparse and the problem is underestimated. A multidisciplinary group of head and neck cancer specialists from Italy met with the aim of reaching a consensus on a clinical definition and management of infections and sepsis. The Delphi appropriateness method was used for this consensus. External expert reviewers then evaluated the conclusions carefully according to their area of expertise. The paper contains seven clusters of statements about the clinical definition and management of infections and sepsis in head and neck cancer patients, which had a consensus. Furthermore, it offers a review of recent literature in these topics

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Section: Statements About Monitoring and Diagnosis Of Sepsismentioning

confidence: 99%

Sepsis in head and neck cancer patients treated with chemotherapy and radiation: Literature review and consensus

Mirabile

Numico²,

Russi

et al. 2015

Critical Reviews in Oncology/Hematology

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“…Therefore, lactate values themselves, their clearances, or clearance rates during certain intervals have often been reported to be useful for evaluating systemic tissue oxygenation and for predicting patient outcome 5, 6, 7, 10, 11, 12. Aduen et al .…”

Section: Discussionmentioning

confidence: 99%

“…adopted hypotension or lactate values ≥4 mmol/L after adequate fluid resuscitation as selection criteria for critically ill patients in their 2001 paper in which they proposed EGDT 5. More recently, there have been several papers reporting that an improvement in outcome could be realized for critical patients with diseases such as severe sepsis by navigating therapy using lactate clearance in the early resuscitation phase 6, 7, 10…”

Section: Discussionmentioning

confidence: 99%

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Early evaluation of severity in patients with severe sepsis: a comparison with “septic shock” — subgroup analysis of the Japanese Association for Acute Medicine Sepsis Registry (JAAM‐SR)

Tarui

Yamaguchi

Suzuki³

et al. 2017

Acute Medicine & Surgery

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AimThe purpose of this subgroup analysis of a Japanese multicenter registry, the Japanese Association for Acute Medicine Sepsis Registry Advanced (JAAM‐SR‐Advanced), was to identify early outcome indicators for severe sepsis that are useful and more objective than “septic shock.”MethodsAmong 624 patients with severe sepsis registered in JAAM‐SR‐Advanced, 554 with valid serum lactate data were retrospectively studied. Hypotension before and after fluid resuscitation and the highest lactate values over the initial 24 h were compared for their ability to predict in‐hospital mortality.ResultsOf the study group, 155 (28.0%) patients were non‐survivors and had significantly lower systolic blood pressures and higher lactate peaks. The mortality of 364 patients with initial hypotension was higher than those patients without it (32.7% versus 19.1%, P < 0.01). Patients with the worst lactate values ≥4 mmol/L had much higher mortality than other patients (P < 0.001). In an attempt to predict outcomes, we combined initial hypotension and the worst lactate values. The patient group with initial hypotension and the worst lactate values ≥4 mmol/L (183 patients, 33.0%) had a significantly higher mortality rate of 48.6% than the other groups (P < 0.01).ConclusionThe novel combined criterion of initial hypotension and the worst lactate values ≥4 mmol/L within the initial 24 h is potentially useful as a single outcome predictor for severe sepsis.

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“…In this issue of Intensive Care Medicine, Peake and colleagues [11] report a systematic review with metaanalysis of five RCTs [1,[8][9][10][11][12] showing no difference in mortality between ED-initiated EGDT versus usual care groups. However, the ED-initiated EGDT group had significantly more use of vasopressors and duration of stay in the ICU.…”

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confidence: 99%

Early goal-directed therapy: from discovery through enthusiasm to equipoise?

2015

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The original Rivers trial [1] of early goal-directed therapy (EGDT) discovered that a process of EGDT that guided fluids, vasopressors, inotropic agents and transfusions in the first 6 h of sepsis dramatically reduced mortality (relative risk reduction, RRR of 42 %) compared to usual care in an emergency department (ED) setting. That discovery ushered in an exciting era of early identification, resuscitation and monitoring of patients with sepsis. Since 2003, EGDT has been recommended in international sepsis guidelines [2][3][4], and implementation in routine care has been associated with benefits [5]. Likewise, many observers suggested that prompt recognition and treatment of sepsis may partly explain declining mortality from sepsis [6,7].Some have suggested that EGDT as described in Rivers' trial may not apply to the intensive care setting, because it was a single-centre trial conducted in the emergency department, the control mortality rate was higher than expected, and baseline central venous oxygen saturation (ScvO 2 ) was remarkably low (about 50 %)-an observation thought to be rare in septic ICU patients. Accordingly, many argued that there was clinical equipoise about the role of EGDT in ICU patients with sepsis, and several subsequent multicentre RCTs [8-10] did not find survival benefits from EGDT (mortality was actually slightly higher in EGDT than the usual care group in ProMISe).In this issue of Intensive Care Medicine, Peake and colleagues [11] report a systematic review with metaanalysis of five RCTs [1,[8][9][10][11][12] showing no difference in mortality between ED-initiated EGDT versus usual care groups. However, the ED-initiated EGDT group had significantly more use of vasopressors and duration of stay in the ICU. Peake and colleagues [11] also reviewed six RCTs of non-ED-initiated EGDT, again finding no difference in mortality between EGDT versus usual care. The systematic review adheres to current standards for the conduct and reporting of a systematic review [13,14], including a pre-experimentally published protocol, a comprehensive search strategy, adequate conventional cumulative meta-analyses, relevant sensitivity and subgroup analyses, and adequate assessment of risk of bias. Conventional cumulative meta-analyses are at risk of producing random errors because of sparse data and repetitive testing of accumulating data [15][16][17]. The risk of random errors can be assessed by trial sequential analysis (TSA), where trial sequential monitoring boundaries are applied to the conventional meta-analysis. The underlying assumption of TSA is that significance testing and calculation of the 95 % confidence interval are performed each time a new trial result is published or available. TSA depends on the accrued information

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Lactate Clearance vs Central Venous Oxygen Saturation as Goals of Early Sepsis Therapy<subtitle>A Randomized Clinical Trial</subtitle>

Cited by 917 publications

References 31 publications

Sepsis in head and neck cancer patients treated with chemotherapy and radiation: Literature review and consensus

Sepsis in head and neck cancer patients treated with chemotherapy and radiation: Literature review and consensus

Early evaluation of severity in patients with severe sepsis: a comparison with “septic shock” — subgroup analysis of the Japanese Association for Acute Medicine Sepsis Registry (JAAM‐SR)

Early goal-directed therapy: from discovery through enthusiasm to equipoise?

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