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

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.