Counterpoint: Should Lactate Clearance Be Substituted for Central Venous Oxygen Saturation as Goals of Early Severe Sepsis and Septic Shock Therapy? No

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Counterpoint: Should Lactate Clearance Be Substituted for Central Venous Oxygen Saturation as Goals of Early Severe Sepsis and Septic Shock Therapy? No Emanuel P. Rivers, MD, MPH, FCCP, Ronald Elkin, MD, Chad M. Cannon, MD CHEST Volume 140, Issue 6, Pages 1408-1413 (December 2011) DOI: 10.1378/chest.11-2563 Copyright © 2011 The American College of Chest Physicians Terms and Conditions

Figure 1 The hemodynamic phases of sepsis. DO2 = systemic oxygen delivery; NI = normal; SvO2 = mixed venous oxygen saturation; VO2 = oxygen consumption. Reprinted with permission from Kruse.8 CHEST 2011 140, 1408-1413DOI: (10.1378/chest.11-2563) Copyright © 2011 The American College of Chest Physicians Terms and Conditions

Figure 2 The kinetics, diagnostic, and therapeutic clinical scenarios of lactate. EGDT = early goal-directed therapy; PRBC = packed RBC; ScvO2 = central venous oxygen saturation. See Figure 1 legend for expansion of other abbreviation. CHEST 2011 140, 1408-1413DOI: (10.1378/chest.11-2563) Copyright © 2011 The American College of Chest Physicians Terms and Conditions