Severe sepsis is the most frequent source of death in severely ill patients . Effective early resuscitation is a very important element of sepsis survival. A few studies have informed that serial lactate measurements have a probable prognostic value during regular sepsis management. This study aims to ascertain whether early lactate clearance correlates with improved survival in emergency department patients with severe sepsis, and to determine the concordance between central venous oxygen saturation optimization and lactate clearance during early sepsis resuscitation.

Arnold et al. analysed prospectively collected registries of consecutive emergency department 166 patients who were diagnosed with severe sepsis at three urban hospitals in the USA. This study included patients older than 17 years who were admitted to the Intensive Care Unit with a suspected infection and either a systolic blood pressure  less than 90 mmHg after 20 mL/kg or greater intravenous fluid or an initial serum lactate 4 mmol/L or greater and initial and repeat lactate measurement within 6 h of resuscitation initiation.

The authors analysed the difference in proportions of death between lactate clearance and non-clearance groups using the binomial test and the associated 95% confidence intervals and P values. All other variables between lactate clearance versus lactate non-clearance groups and between survivors versus nonsurvivors were compared using the binomial test or Student T-test when applicable.

Arnold et al. found that early lactate clearance was a steady independent predictor of in-hospital mortality in Emergency Department patients with severe sepsis. Moreover, an increment of central venous oxygen saturation during resuscitation was not sufficient to reliably exclude lactate non-clearance.

This article was writtenby Arnold et al. and on behalf of the Emergency Medicine Shock Research Network (EMShockNet) Investigators, and it was published back in 2009 by the Shock Society (Vol. 32, No. 1, pp. 35Y39, 2009)

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