PMID- 30813144
OWN - NLM
STAT- MEDLINE
DCOM- 20190311
LR  - 20200225
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Print)
IS  - 0025-7974 (Linking)
VI  - 98
IP  - 8
DP  - 2019 Feb
TI  - Relative efficacy and safety of early lactate clearance-guided therapy 
      resuscitation in patients with sepsis: A meta-analysis.
PG  - e14453
LID - 10.1097/MD.0000000000014453 [doi]
LID - e14453
AB  - OBJECTIVE: Compelling evidence has shown that aggressive resuscitation bundles 
      are one of the cornerstones of the successful treatment of patients with sepsis. 
      Recent studies suggest that lactate normalization during resuscitation is a more 
      powerful indicator of resuscitative adequacy; however, early lactate 
      clearance-guided therapy is still not recommended. We performed this 
      meta-analysis to evaluate the effect of early lactate clearance-directed therapy 
      as a potentially more effective resuscitation target. METHODS: Studies were 
      identified using PubMed, Embase, and the Cochrane Library without region, 
      publication type, or language restrictions. Randomized trials were included when 
      they compared the efficacy and safety of lactate clearance-guided resuscitation 
      versus central venous oxygen saturation (ScvO2)-guided therapy. The primary 
      outcome was mortality, and the secondary outcomes were intensive care unit (ICU) 
      stay, length of hospital stay, mechanical ventilation time, Acute Physiology and 
      Chronic Health Evaluation-II (APACHE-II) score, and Sepsis-related Organ Failure 
      Assessment (SOFA) score. RESULTS: Seven randomized controlled trials encompassing 
      1301 cases were reviewed. Compared with guided ScvO2 therapy, early lactate 
      clearance-directed therapy was associated with decreased in-hospital mortality 
      (relative ratio [RR] 0.68, 95% confidence interval [CI] 0.56 to 0.82), shorter 
      ICU stay (mean difference [MD] -1.64 days, 95% CI -3.23 to -0.05), shorter 
      mechanical ventilation time (MD -10.22 hours, 95% CI -15.94 to -4.5), and lower 
      APACHE-II scores (MD -4.47, 95% CI -7.25 to -1.69). However, patients undergoing 
      early lactate clearance-guided therapy had similar lengths of hospital stay and 
      similar SOFA scores. CONCLUSIONS: As a specific indicator of resuscitation 
      outcome, lactate clearance alone is superior to ScvO2 alone during a standard 
      resuscitation paradigm. The optimal or desired rate of lactate clearance is still 
      a contentious area. To guide resuscitation and normalize lactate levels in 
      patients, repeating lactate measurements every 2 hours until the patient has met 
      a lactate clearance of 10% or greater may be helpful. TRIAL REGISTRATION NUMBER: 
      PROSPERO CRD42018100515.
FAU - Pan, Jianzhen
AU  - Pan J
AD  - Department of Emergency Medicine.
FAU - Peng, Milin
AU  - Peng M
AD  - Department of Critical Care Medicine, Xiang Ya Hospital, Central South 
      University, Changsha, Hunan, China.
FAU - Liao, Chao
AU  - Liao C
AD  - Department of Emergency Medicine.
FAU - Hu, Xia
AU  - Hu X
AD  - Department of Emergency Medicine.
FAU - Wang, Aimin
AU  - Wang A
AD  - Department of Emergency Medicine.
FAU - Li, Xiangmin
AU  - Li X
AD  - Department of Emergency Medicine.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Biomarkers)
RN  - 33X04XA5AT (Lactic Acid)
RN  - S88TT14065 (Oxygen)
SB  - IM
MH  - Biomarkers/*blood
MH  - Hospital Mortality
MH  - Humans
MH  - Intensive Care Units/statistics & numerical data
MH  - Lactic Acid/*blood
MH  - Length of Stay/statistics & numerical data
MH  - Organ Dysfunction Scores
MH  - Oxygen/*blood
MH  - Prognosis
MH  - Respiration, Artificial/statistics & numerical data
MH  - Resuscitation/*methods
MH  - Secondary Prevention/methods
MH  - Sepsis/blood/mortality/*therapy
PMC - PMC6408023
COIS- The authors report no conflicts of interests.
EDAT- 2019/03/01 06:00
MHDA- 2019/03/12 06:00
PMCR- 2019/02/22
CRDT- 2019/03/01 06:00
PHST- 2019/03/01 06:00 [entrez]
PHST- 2019/03/01 06:00 [pubmed]
PHST- 2019/03/12 06:00 [medline]
PHST- 2019/02/22 00:00 [pmc-release]
AID - 00005792-201902220-00024 [pii]
AID - MD-D-18-08314 [pii]
AID - 10.1097/MD.0000000000014453 [doi]
PST - ppublish
SO  - Medicine (Baltimore). 2019 Feb;98(8):e14453. doi: 10.1097/MD.0000000000014453.