Background: Early and appropriate management of patients with sepsis and septic shock markedly improves the clinical outcomes and decreases the mortality rate.
Methods: It was a prospective randomized study in which 62 adult septic patients of both sexes were randomly assigned to either ScvO2 group or lactate clearance group. All patients were resuscitated to optimize central venous pressure and mean arterial pressure then targeting either ScvO2 of at least 70% or lactate clearance of at least 20%. The study protocol was continued until all goals were achieved or up to 6 hours. Mortality at 28 days was measured for all patients. All the obtained data showed no significant differences between the two main groups except for the duration of the vasopressor free days. Thereby, two subgroups were created from the same acquired data as a ScvO2 only subgroup (n=12) and Lactate clearance only subgroup (n=10).
Results: The overall mortality was 51.6%. Main group analysis revealed comparable results except for the duration of vasopressor free days which was longer in lactate clearance group. Subgroup results: the mortality rate was significantly lower in lactate clearance only subgroup [20% (2/10)] versus [75% (9/12)] in ScvO2 only subgroup. Moreover, the durations of vasopressors and organ failure free days were longer in lactate clearance only subgroup.
Conclusion: Achievement of lactate clearance of ≥ 20% goal only was associated with lower rate of mortality and better clinical outcomes than achievement of ScvO2 ≥ 70% goal only during early resuscitation of septic patients.