Evolutive standard base excess and serum lactate level in severe sepsis and septic shock patients resuscitated with early goal-directed therapy: still outcome markers?
OBJECTIVE
To compare the evolution of standard base excess and serum lactate level between surviving and non surviving patients with severe sepsis and septic shock resuscitated with early goal-directed therapy.


METHODS
This is a retrospective study in an intensive care unit of a university tertiary hospital where 65 consecutive severe sepsis and septic shock patients were observed without any intervention in the treatment by the authors of this report.


RESULTS
In our study, the mortality of severe sepsis and septic shock patients was 38%. The central venous oxygen saturation of both groups was above 70% after the resuscitative period, excluding the second day of the non survivors group (69.8%). After the second day, the central venous oxygen saturation was significantly higher in the survivors group (P < .001). Standard base excess was initially low in both groups, but from the second day on, the correction of standard base excess was significantly more successful and linear in the survivor group (P < .001). Lactate levels were similar during the evolution of both groups.


CONCLUSIONS
Although evolutive standard base excess and serum lactate level are still outcome markers in severe sepsis and septic shock patients resuscitated with early goal-directed therapy, other studies must be performed to clarify if hemodynamic interventions based on standard base excess and serum lactate level could be reliable to improve clinical outcomes in severe sepsis and septic shock patients.
Intensive Care Unit, Emergency Department, São Paulo University Medical School--São Paulo/SP, Brazil. mpark@uol.com.br
Marcelo
M
Park
Luciano Cesar Pontes
LC
Azevedo
Alexandre Toledo
AT
Maciel
Vladimir Ribeiro
VR
Pizzo
Danilo Teixeira
DT
Noritomi
Luiz Monteiro
LM
da Cruz Neto
D018806:APACHE; D000136:Acid-Base Equilibrium / Q000502:physiology*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012151:Resuscitation / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood / Q000401:mortality / Q000628:therapy*; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000097:blood / Q000401:mortality / Q000628:therapy
D015415:Biomarkers; D019344:Lactic Acid