Use of stepwise lactate kinetics-oriented hemodynamic therapy could improve the clinical outcomes of patients with sepsis-associated hyperlactatemia

• Published in: Critical care (London, England) Vol. 21; no. 1; p. 33
• Main Authors: Zhou, Xiang, Liu, Dawei, Su, Longxiang, Yao, Bo, Long, Yun, Wang, Xiaoting, Chai, Wenzhao, Cui, Na, Wang, Hao, Rui, Xi
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 16.02.2017; BioMed Central
• Subjects: Analysis; Bilirubin; Care and treatment; Clinical outcomes; Critical care; Dosage and administration; Health aspects; Hemodynamic monitoring; Lactic acidosis; Practice guidelines (Medicine); Sepsis; ScvO2; Sepsis; Septic shock; Lactate kinetics; Hemodynamic therapy
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1366-609X
• DOI: 10.1186/s13054-017-1617-1

Setting lactate kinetics at >30% might improve the clinical outcomes of patients with sepsis-associated hyperlactatemia. The aim of this study was to explore the outcome benefits of stepwise lactate kinetics vs central venous oxygen saturation (ScvO )-oriented hemodynamic therapy at 6 h as the protocol goal during early resuscitation. The relevant parameters and adverse events after different targets in 360 randomly assigned patients with sepsis-associated hyperlactatemia were recorded and compared. Heart rate (HR) at 48 h in the ScvO group was higher than in the lactate kinetics group (105 ± 19 bpm vs 99 ± 20 bpm, P = 0.040). The liquid balance at 4 h, 12 h, and 24 h in the lactate kinetics group was larger than in the ScvO group (1535 (1271-1778) ml vs 826 (631-1219) ml, P < 0.001; 1688 (1173-1923) ml vs 1277 (962 - 1588) ml, P <0.001; and 1510 (904-2087) ml vs 1236 (740-1808) ml, P = 0.005), respectively. Mortality was higher in the ScvO group (27.9% vs 18.3%, P = 0.033), but there was no significant difference between the two groups in the length of stay in the ICU or mechanical ventilation. In terms of new onset organ dysfunction, there was a significant difference between the two groups in total bilirubin at 48 h and 72 h. Based on the 60-day survival curves, there was significantly more mortality in the ScvO group than in the lactate kinetics group (X  = 4.133, P = 0.042). In addition, fewer adverse events occurred in the lactate kinetics group. Stepwise lactate kinetics-oriented hemodynamic therapy can reduce mortality in patients with sepsis-associated hyperlactatemia compared with ScvO -oriented therapy. National Institutes of Health Clinical Trials Registry, NCT02566460 . Registered on 26 September 2015.