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Comment & Response
July 9, 2019

Resuscitation Strategies Using Peripheral Perfusion vs Serum Lactate Levels—Reply

Author Affiliations
  • 1Departmento de Medicina Intensiva, Pontificia Universidad Católica de Chile, Santiago
JAMA. 2019;322(2):173. doi:10.1001/jama.2019.6035

In Reply We agree with Drs Patel and Bergl that many studies of septic shock have overestimated control group mortality and effect size. However, in the ANDROMEDA-SHOCK trial,1 the delta for mortality in the control group was only 1.6% (expected 45% minus actual 43.4%). This is lower than reported in other studies.2 The problem with our study was overestimation of the effect size: 15% anticipated vs 8% actual. We based our effect size on studies that have reported on early resuscitation and high mortality in patients with persistently abnormal peripheral perfusion after initial resuscitation, given the limitations of lactate to reflect adequate resuscitation.3,4 However, the expected and actual mortality of the control group were close to the rates used in the Sepsis-3 definitions of septic shock (intensive care unit mortality, 47%; hospital mortality, 56%).5