Targeted Lactate Clearance in the Management of Patients with Sepsis and Septic Shock: A Systematic Review and Meta-analysis of Randomized Trials
CCCF ePoster library. Sharma S. Nov 1, 2016; 150966; 85
Dr. Sunjay Sharma
Dr. Sunjay Sharma
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Topic: Systematic Review, Meta-analysis, or Meta-synthesis

Targeted Lactate Clearance in the Management of Patients with Sepsis and Septic Shock: A Systematic Review and Meta-analysis of Randomized Trials

Sharma, Sunjay1; Alshamsi, Fayez2; Antonelli, Massimo3; Rhodes, Andrew4; Evans, Laura5; Baw, Bandar6; Ananne, Dijillali7; Alhazzani, Waleed8,9

1Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Canada; 2Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE; 3Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A.Gemelli-Università  Cattolica, Rome, Italy; 4Department of Intensive Care Medicine, St George’s Hospital, London, UK; 5Department of Medicine, Division of Pulmonary Medicine and Critical Care, New York University, New York, USA; 6Department of Emergency Medicine, McMaster University, Hamilton, Canada; 7Intensive Care Unit, Raymond Poincaré hospital (APHP), University of Versailles SQY, Garches, France; 8Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Canada; 9Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada



INTRODUCTION: Fluid resuscitation is the cornerstone of management of septic patients. However, resuscitation can be driven by clinical parameters alone or using lactate as a marker to guide treatment.

OBJECTIVES: We chose to examine the effect of lactate guided resuscitation on mortality and intesnsive care unit length of stay (ICU LOS) in septic patients.

METHODS: We searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials through August 2016 without language or date of publication restrictions. We included randomized controlled trials (RCTs) if they compared resuscitation guided by lactate clearance compared to usual care in patients with sepsis and septic shock for the outcomes of mortality and ICU LOS. Two reviewers independently screened titles and abstracts for eligibility and extracted data in duplicate. We used the Cochrane Collaboration tool to assess the risk of bias, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE ) method to assess the quality of the evidence. 

RESULTS: Our initial search identified 949 titles out of which we included 5 RCT's enrolling 647 patients. Lactate clearance guided resuscitation (n=336) was associated with lower mortality than usual care (n=311) (relative risk 0.67; 95% CI 0.53, 0.84; P= 0.0004; I2=0%; moderate quality). The ICU LOS was similar in both groups (mean difference -2.68 days; 95% CI -5.51, 0.16; P=0.06; I2=76%; low quality).

CONCLUSION: Moderate quality evidence showed that incorporating lactate reduction goals into resuscitation of septic patients reduced mortality, but had no impact on ICU length of stay.

  1. Jones AE, Shapiro NI, Trzeciak S, et al. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA. 2010;303(8):739-746.
  2. Lyu X, Xu Q, Cai G, Yan J, Yan M. [Efficacies of fluid resuscitation as guided by lactate clearance rate and central venous oxygen saturation in patients with septic shock]. Chung Hua I Hsueh Tsa Chih. 2015;95(7):496-500.
  3. Tian HH, Han SS, Lv CJ, et al. [The effect of early goal lactate clearance rate on the outcome of septic shock patients with severe pneumonia]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2012;24(1):42-45.
  4. Yu B, Tian HY, Hu ZJ, et al. [Comparison of the effect of fluid resuscitation as guided either by lactate clearance rate or by central venous oxygen saturation in patients with sepsis]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2013;25(10):578-583.
  5. Jansen TC, van Bommel J, Schoonderbeek FJ, et al. Early lactate-guided therapy in intensive care unit patients: a multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med. 2010;182(6):752-761.

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