CARING FOR THE CRITICALLY ILL PATIENT Lactate Clearance vs Central Venous Oxygen Saturation as Goals of Early Sepsis Therapy A Randomized Clinical Trial

THE RATE OF SEVERE SEPSIS HOSpitalizations has doubled during the last decade with estimates indicating that at least 750 000 persons are affected annually in the United States. Approximately, 500 000 patients with severe sepsis in the United States annually are initially treated in emergency departments. The Surviving Sepsis Campaign international consensus guidelines recommend protocol-driven treatment that uses quantitative resuscitation for emergency department patients with severe sepsis and septic shock. Quantitative resuscitation refers to the use of an explicit protocol that targets predefined physiological or laboratory goals to be achieved within the first several hours. This concept was pioneered by Shoemaker et al to treat high-risk surgical patients. Results of a recent meta-analysis indicated a survival benefit associated with the use of