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Published in: Lung 3/2014

01-06-2014

Prognostic Value of Central Venous Oxygen Saturation and Blood Lactate Levels Measured Simultaneously in the Same Patients with Severe Systemic Inflammatory Response Syndrome and Severe Sepsis

Authors: Ju-Hee Park, Jinwoo Lee, Young Sik Park, Chang-Hoon Lee, Sang-Min Lee, Jae-Joon Yim, Young Whan Kim, Sung Koo Han, Chul-Gyu Yoo

Published in: Lung | Issue 3/2014

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Abstract

Background

Blood lactate levels and central venous oxygen saturation (ScvO2) are known to be useful indicators of global tissue hypoxia. However, it is unclear whether ScvO2 correlates with lactate levels when measured simultaneously and whether changes in ScvO2 or lactate levels in serial measurements have prognostic value. We investigated the correlation between ScvO2 and lactate levels measured simultaneously and their association with clinical outcomes.

Methods

We performed a prospective observational study of patients with severe systemic inflammatory response syndrome (SIRS) and severe sepsis who were admitted to the medical intensive care unit. ScvO2 and lactate levels were measured simultaneously at the time of study enrollment, every 6 h for 24 h, and then every 24 h until the goal was reached.

Results

Twenty-five patients were enrolled in the study; 13 have died and 12 have survived. There was no correlation between lactate levels and ScvO2. Neither lactate levels nor ScvO2 at the time of admission differed between nonsurvivors and survivors. Normalization of lactate levels within 48 h was significantly associated with survival.

Conclusions

In patients with severe SIRS and severe sepsis, simultaneously measured ScvO2 and lactate levels showed no correlation, and normalization of lactate levels within 48 h was a predictive factor for survival.
Literature
1.
go back to reference Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101(6):1644–1655CrossRefPubMed Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101(6):1644–1655CrossRefPubMed
2.
go back to reference Astiz ME, Rackow EC, Falk J, Kaufman BS, Weil M (1987) Oxygen delivery and consumption in patients with hyperdynamic septic shock. Crit Care Med 15(1):26–28CrossRefPubMed Astiz ME, Rackow EC, Falk J, Kaufman BS, Weil M (1987) Oxygen delivery and consumption in patients with hyperdynamic septic shock. Crit Care Med 15(1):26–28CrossRefPubMed
3.
go back to reference Otero RM, Nguyen HB, Huang DT, Gaieski DF, Goyal M, Gunnerson KJ, Trzeciak S, Sherwin R, Holthaus CV, Osborn T (2006) Early goal-directed therapy in severe sepsis and septic shock revisited: concepts, controversies, and contemporary findings. Chest 130(5):1579–1595CrossRefPubMed Otero RM, Nguyen HB, Huang DT, Gaieski DF, Goyal M, Gunnerson KJ, Trzeciak S, Sherwin R, Holthaus CV, Osborn T (2006) Early goal-directed therapy in severe sepsis and septic shock revisited: concepts, controversies, and contemporary findings. Chest 130(5):1579–1595CrossRefPubMed
4.
go back to reference Parrillo JE, Parker MM, Natanson C, Suffredini AF, Danner RL, Cunnion RE, Ognibene FP (1990) Septic shock in humans. Advances in the understanding of pathogenesis, cardiovascular dysfunction, and therapy. Ann Intern Med 113(3):227–242CrossRefPubMed Parrillo JE, Parker MM, Natanson C, Suffredini AF, Danner RL, Cunnion RE, Ognibene FP (1990) Septic shock in humans. Advances in the understanding of pathogenesis, cardiovascular dysfunction, and therapy. Ann Intern Med 113(3):227–242CrossRefPubMed
5.
go back to reference Astiz ME, Rackow EC, Kaufman B, Falk J, Weil M (1988) Relationship of oxygen delivery and mixed venous oxygenation to lactic acidosis in patients with sepsis and acute myocardial infarction. Crit Care Med 16(7):655–658CrossRefPubMed Astiz ME, Rackow EC, Kaufman B, Falk J, Weil M (1988) Relationship of oxygen delivery and mixed venous oxygenation to lactic acidosis in patients with sepsis and acute myocardial infarction. Crit Care Med 16(7):655–658CrossRefPubMed
6.
go back to reference Muckart DJ, Bhagwanjee S (1997) American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference definitions of the systemic inflammatory response syndrome and allied disorders in relation to critically injured patients. Crit Care Med 25(11):1789–1795CrossRefPubMed Muckart DJ, Bhagwanjee S (1997) American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference definitions of the systemic inflammatory response syndrome and allied disorders in relation to critically injured patients. Crit Care Med 25(11):1789–1795CrossRefPubMed
7.
10.
go back to reference McCarter FD, Nierman SR, James JH, Wang L, King JK, Friend LA, Fischer JE (2002) Role of skeletal muscle Na+–K+ ATPase activity in increased lactate production in sub-acute sepsis. Life Sci 70(16):1875–1888CrossRefPubMed McCarter FD, Nierman SR, James JH, Wang L, King JK, Friend LA, Fischer JE (2002) Role of skeletal muscle Na+–K+ ATPase activity in increased lactate production in sub-acute sepsis. Life Sci 70(16):1875–1888CrossRefPubMed
12.
13.
14.
go back to reference Sevransky JE, Nour S, Susla GM, Needham DM, Hollenberg S, Pronovost P (2007) Hemodynamic goals in randomized clinical trials in patients with sepsis: a systematic review of the literature. Crit Care 11(3):R67PubMedCentralCrossRefPubMed Sevransky JE, Nour S, Susla GM, Needham DM, Hollenberg S, Pronovost P (2007) Hemodynamic goals in randomized clinical trials in patients with sepsis: a systematic review of the literature. Crit Care 11(3):R67PubMedCentralCrossRefPubMed
15.
go back to reference Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL, International Surviving Sepsis Campaign Guidelines Committee; American Association of Critical-Care Nurses; American College of Chest Physicians; American College of Emergency Physicians; Canadian Critical Care Society; European Society of Clinical Microbiology and Infectious Diseases; European Society of Intensive Care Medicine; European Respiratory Society; International Sepsis Forum; Japanese Association for Acute Medicine; Japanese Society of Intensive Care Medicine; Society of Critical Care Medicine; Society of Hospital Medicine; Surgical Infection Society; World Federation of Societies of Intensive and Critical Care Medicine (2008) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 36(1):296–327. doi:10.1097/01.CCM.0000298158.12101.41 Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL, International Surviving Sepsis Campaign Guidelines Committee; American Association of Critical-Care Nurses; American College of Chest Physicians; American College of Emergency Physicians; Canadian Critical Care Society; European Society of Clinical Microbiology and Infectious Diseases; European Society of Intensive Care Medicine; European Respiratory Society; International Sepsis Forum; Japanese Association for Acute Medicine; Japanese Society of Intensive Care Medicine; Society of Critical Care Medicine; Society of Hospital Medicine; Surgical Infection Society; World Federation of Societies of Intensive and Critical Care Medicine (2008) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 36(1):296–327. doi:10.​1097/​01.​CCM.​0000298158.​12101.​41
16.
go back to reference Roy A (2006) Estimating correlation coefficient between two variables with repeated observations using mixed effects model. Biom J 48(2):286–301CrossRefPubMed Roy A (2006) Estimating correlation coefficient between two variables with repeated observations using mixed effects model. Biom J 48(2):286–301CrossRefPubMed
17.
go back to reference Otero RM, Nguyen HB, Huang DT, Gaieski DF, Goyal M, Gunnerson KJ, Trzeciak S, Sherwin R, Holthaus CV, Osborn T, Rivers EP (2006) Early goal-directed therapy in severe sepsis and septic shock revisited: concepts, controversies, and contemporary findings. Chest 130(5):1579–1595. doi:10.1378/chest.130.5.1579 CrossRefPubMed Otero RM, Nguyen HB, Huang DT, Gaieski DF, Goyal M, Gunnerson KJ, Trzeciak S, Sherwin R, Holthaus CV, Osborn T, Rivers EP (2006) Early goal-directed therapy in severe sepsis and septic shock revisited: concepts, controversies, and contemporary findings. Chest 130(5):1579–1595. doi:10.​1378/​chest.​130.​5.​1579 CrossRefPubMed
18.
go back to reference Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M, Early Goal-Directed Therapy Collaborative Group (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345(19):1368–1377. doi:10.1056/NEJMoa010307 CrossRefPubMed Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M, Early Goal-Directed Therapy Collaborative Group (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345(19):1368–1377. doi:10.​1056/​NEJMoa010307 CrossRefPubMed
21.
go back to reference Perel A (2008) Bench-to-bedside review: the initial hemodynamic resuscitation of the septic patient according to Surviving Sepsis Campaign guidelines—does one size fit all? Crit Care 12(5):223PubMedCentralCrossRefPubMed Perel A (2008) Bench-to-bedside review: the initial hemodynamic resuscitation of the septic patient according to Surviving Sepsis Campaign guidelines—does one size fit all? Crit Care 12(5):223PubMedCentralCrossRefPubMed
23.
go back to reference Puskarich MA, Trzeciak S, Shapiro NI, Arnold RC, Heffner AC, Kline JA, Jones AE, Emergency Medicine Shock Research Network (EMSHOCKNET) (2012) Prognostic value and agreement of achieving lactate clearance or central venous oxygen saturation goals during early sepsis resuscitation. Acad Emerg Med 19(3):252–258. doi:10.1111/j.1553-2712.2012.01292.x PubMedCentralCrossRefPubMed Puskarich MA, Trzeciak S, Shapiro NI, Arnold RC, Heffner AC, Kline JA, Jones AE, Emergency Medicine Shock Research Network (EMSHOCKNET) (2012) Prognostic value and agreement of achieving lactate clearance or central venous oxygen saturation goals during early sepsis resuscitation. Acad Emerg Med 19(3):252–258. doi:10.​1111/​j.​1553-2712.​2012.​01292.​x PubMedCentralCrossRefPubMed
24.
go back to reference Bakker J, Coffernils M, Leon M, Gris P, Vincent JL (1991) Blood lactate levels are superior to oxygen-derived variables in predicting outcome in human septic shock. Chest 99(4):956–962CrossRefPubMed Bakker J, Coffernils M, Leon M, Gris P, Vincent JL (1991) Blood lactate levels are superior to oxygen-derived variables in predicting outcome in human septic shock. Chest 99(4):956–962CrossRefPubMed
26.
go back to reference Jansen TC, van Bommel J, Schoonderbeek FJ, Visser SJS, van der Klooster JM, Lima AP, Willemsen SP, Bakker J (2010) Early lactate-guided therapy in intensive care unit patients: a multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med 182(6):752–761CrossRefPubMed Jansen TC, van Bommel J, Schoonderbeek FJ, Visser SJS, van der Klooster JM, Lima AP, Willemsen SP, Bakker J (2010) Early lactate-guided therapy in intensive care unit patients: a multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med 182(6):752–761CrossRefPubMed
27.
go back to reference Di Filippo A, Gonnelli C, Perretta L, Zagli G, Spina R, Chiostri M, Gensini GF, Peris A (2009) Low central venous saturation predicts poor outcome in patients with brain injury after major trauma: a prospective observational study. Scand J Trauma Resusc Emerg Med 17:23PubMedCentralCrossRefPubMed Di Filippo A, Gonnelli C, Perretta L, Zagli G, Spina R, Chiostri M, Gensini GF, Peris A (2009) Low central venous saturation predicts poor outcome in patients with brain injury after major trauma: a prospective observational study. Scand J Trauma Resusc Emerg Med 17:23PubMedCentralCrossRefPubMed
28.
go back to reference Huh JW, Oh BJ, Lim CM, Hong SB, Koh Y (2012) Comparison of clinical outcomes between intermittent and continuous monitoring of central venous oxygen saturation (ScvO2) in patients with severe sepsis and septic shock: a pilot study. Emerg Med J 30(11):906–909CrossRefPubMed Huh JW, Oh BJ, Lim CM, Hong SB, Koh Y (2012) Comparison of clinical outcomes between intermittent and continuous monitoring of central venous oxygen saturation (ScvO2) in patients with severe sepsis and septic shock: a pilot study. Emerg Med J 30(11):906–909CrossRefPubMed
29.
go back to reference Ising P, Smith TW, Simpson SQ (2009) Effect of intermittent vs continuous ScvO2 monitoring on sepsis bundle compliance and mortality. Chest 136(4):21 Ising P, Smith TW, Simpson SQ (2009) Effect of intermittent vs continuous ScvO2 monitoring on sepsis bundle compliance and mortality. Chest 136(4):21
30.
go back to reference Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb S, Beale RJ, Vincent JL, Moreno R, Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup (2013) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 39(2):165–228CrossRefPubMed Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb S, Beale RJ, Vincent JL, Moreno R, Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup (2013) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 39(2):165–228CrossRefPubMed
Metadata
Title
Prognostic Value of Central Venous Oxygen Saturation and Blood Lactate Levels Measured Simultaneously in the Same Patients with Severe Systemic Inflammatory Response Syndrome and Severe Sepsis
Authors
Ju-Hee Park
Jinwoo Lee
Young Sik Park
Chang-Hoon Lee
Sang-Min Lee
Jae-Joon Yim
Young Whan Kim
Sung Koo Han
Chul-Gyu Yoo
Publication date
01-06-2014
Publisher
Springer US
Published in
Lung / Issue 3/2014
Print ISSN: 0341-2040
Electronic ISSN: 1432-1750
DOI
https://doi.org/10.1007/s00408-014-9564-y

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