NEW YORK (Reuters Health) – During early resuscitation in severe sepsis, lactate clearance can indicate tissue oxygen delivery as effectively as central venous oxygen saturation, with considerably less effort, new research shows.

The guideline recommending use of central venous catheters and computerized spectrophotometry to monitor oxygen saturation in sepsis is based on a single-center study, lead author Dr. Alan E. Jones and associates write in the February 24th Journal of the American Medical Association.

Furthermore, that approach is time-consuming and requires expertise and specialized equipment not always available even in tertiary care emergency departments.

In a prospective, multicenter, noninferiority trial, Dr. Jones, from Carolinas Medical Center, Charlotte, North Carolina, and his colleagues compared the two strategies to as part of an overall attempt to establish goal-directed therapy targets.

Treatment goals were first, to attain a central venous pressure of 8 mm Hg or higher using volume expansion, followed by vasopressors, if necessary, to achieve a mean arterial pressure of 65 mm Hg or higher.

The final goal was to use red blood cells and dobutamine to achieve adequate tissue oxygen delivery. Toward this end, patients were randomized to one of two strategies: (1) attaining a central venous oxygen saturation of at least 70%, or (2) achieving a lactate clearance of at least 10% over 2 hours.

The investigators note that all patients had central lines placed; in the lactate group,