Mary Ann, Practically there needs to be a specific definition of targets and goals. Targets are going to have to be arbitrary until there is a larger evidence base. And most likely that evidence will never be compelling or at the very least a long time in coming.
The final goal is normalization of lactate and patient survival. However, an hourly goal of a % reduction or 10% might be reasonable. You make an interesting point. You suggest that going from 3.9 to 3.5 is very different than improving from 8.9 to 8.0. So what do you specifically suggest for the use of lactate. I believe that several groups have used the term lactate clearance and a 10% reduction of 1-2 hours as evidence of progress. And that therapy is moving patent in the right direction when lactate clearance is 10% or greater. While no change or an increase means that therapy is not working and should be adjusted. I am being too simplistic perhaps, but what would you suggest? George C Kramer, PhD Director, Resuscitation Research Lab Professor, Dept. of Anesthesiology 301 University Blvd. UTMB, Galveston, TX 77555-1102 Office (Mary) 409-747-0077 Direct: 409-772-3969 Cell: 409-939-3040 Lab (Muzna) 409-772-6885 Fax: 409-772-8895 UTMB email: [email protected] http://www.utmb.edu/rrl/ From: <Daly>, Mary Ann <[email protected]<mailto:[email protected]>> Date: Wednesday, May 1, 2013 2:01 PM To: 'Ram Parekh' <[email protected]<mailto:[email protected]>>, 'Vipul Kella' <[email protected]<mailto:[email protected]>> Cc: "'[email protected]<mailto:'[email protected]>'" <[email protected]<mailto:[email protected]>> Subject: Re: [Sepsis Groups] Noninvasive EGDT I am surprised that the ‘non-inferiority study’ referenced here would lead to treatment protocols with endpoints that were not endorsed by the Surviving Sepsis Campaign. Among the flaws in that study was the arbitrary choice of a ‘10% reduction in lactate levels’. In addition to the fact that this per cent reduction was arbitrary, I think that we can all agree that there is quite a difference in a 10% reduction in a lactate of 3.9 and a 10% reduction in a lactate of lactate of 8.9. Although the new SSC guidelines include targets for serum lactate reduction(begrudgingly to satisfy NQF - IMHO), the goal of the reduction is not by some arbitrary number - but normalized. $0.02 Thanks, Mary Ann Daly, RN BSN CCRN DC Regional Clinical Initiative Lead-Sepsis and ICU Liberation (ABCDE) Gordon and Betty Moore Foundation Grant Sutter Health Sacramento Sierra Region E-mail:[email protected]<mailto:[email protected]> Blackberry:916.200.5604 Office: 916.614.6370 You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete. R. Buckminster Fuller From: [email protected]<mailto:[email protected]> [mailto:[email protected]] On Behalf Of Ram Parekh Sent: Tuesday, April 30, 2013 1:50 PM To: Vipul Kella Cc: [email protected]<mailto:[email protected]> Subject: Re: [Sepsis Groups] Noninvasive EGDT We have at our hospital and at most of the GNYHA hospitals in the New York area. This protocol is based on the non-inferiority study of lactate clearance by Jones/Shapiro and was implemented with our current Stop Sepsis collaborative which has given ED providers the option of utilizing the 'invasive' or 'non-invasive protocol' as EGDT options. Thus, the protocol was simultaneously implemented in over 50 hospitals at the same time. On Mon, Apr 29, 2013 at 9:57 AM, Vipul Kella <[email protected]<mailto:[email protected]>> wrote: Has anyone implemented the noninvasive EGDT protocol at their hospital? What was your experience? -- Vipul Kella, MD FACEP Medical Emergency Professionals (MEP) _______________________________________________ Sepsisgroups mailing list [email protected]<mailto:[email protected]> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
