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May 26, 2010

Lactate Clearance and Central Venous Oxygen Saturation in Early Sepsis—Reply

JAMA. 2010;303(20):2031-2032. doi:10.1001/jama.2010.659

In Reply: We have 2 responses to the concerns of Drs Sauneuf and Charbonneau that the population we enrolled in our study may have lower illness severity than might be predicted in a severe sepsis trial and is different than that enrolled in the study by Rivers et al.1 First, we based our inclusion criteria on the same set of criteria used in the study by Rivers et al: (1) suspected infection, (2) two or more systemic inflammatory response criteria, and (3) evidence of hypoperfusion manifested by either refractory hypotension (systolic blood pressure <90 mm Hg after a fluid challenge) or an elevated lactate level. These criteria are currently recommended by the Surviving Sepsis Campaign2 to identify patients in need of goal-directed resuscitation and are the same inclusion criteria being used by the multicenter ProCESS trial and the ARISE trials. Moreover, these inclusion criteria produced a population that manifested severity of illness and organ dysfunction scores with a greater than 30% predicted mortality. Thus, we believe that this study population is an accurate contemporaneous representation of severe sepsis and septic shock populations encountered in US emergency departments.