Studies demonstrating the efficacy of early goal-directed therapy have targeted a central venous oxygen saturation (ScvO2) of 70 percent.* For hypotensive patients who have not responded to fluid resuscitation or for those patients with lactate > 4 mmol/L (36 mg/dl), ScvO2 should be maintained at or greater than 70 percent in order to reproduce the mortality reductions cited in the literature.
Compliance with this Sepsis Resuscitation Bundle element is defined as the percent of patients following septic shock or lactate > 4 mmol/L (36 mg/dl) identification for whom the ScvO2 is > 70 percent (or SvO2 is > 65 percent) within 6 hours of presentation time.
Note: While it may not be possible to attain the recommended oxygen saturation values in all patients despite optimal therapies (such as blood to achieve hematocrit > 30 percent and maximum-dose inotropes), the proportion of patients for whom this is true remains a constant. Therefore, although credit is not assigned for failure to achieve ScvO2 > 70 percent (or SvO2 is > 65 percent) despite optimal therapy, this defect can be factored into any comparative evaluation of results. Teams are encouraged to maximize their individual results.
Numerator: The number of patients with severe sepsis with lactate > 4 mmol/L (36 mg/dl) or septic shock for whom a ScVO2 goal > 70 percent (or SvO2 goal > 65 percent) is achieved within 6 hours of presentation time.
Denominator: The number of patients with severe sepsis with lactate > 4 mmol/L (36 mg/dl) or septic shock.
Exclusion: Patients with non-severe sepsis or severe sepsis with lactate < 4 mmol/L (36 mg/dl).
*Mixed venous oxygen saturation (SvO2) > 65 percent may be substituted.
