Statement from the Surviving Sepsis Campaign Leadership on CVP, ScvO2, and Lactate Measurements

Until data are available that can provide evidence-based recommendations for the use of alternate methods of obtaining clinical measurements that guide appropriate therapy during initial resuscitation for severe sepsis, the Surviving Sepsis Campaign leadership recommends targeting central venous pressure (CVP) of 8-12 mm Hg, superior vena cava oxygen saturation (SCVO2) of 70 % (or mixed venous oxygen saturation [SVO2] of 65%) and lactate normalization (1,2). Although the original sepsis bundles included targets, the decision about how this goal would best be achieved was left to the treating clinician (3,4). The current guidelines continue to recommend these target measures, while the performance indicators for bundle compliance now call for measuring CVP and SCVO2, and re-measuring lactate if the initial lactate was elevated. The rationale for the indicators ’ being measurement and not target achievement is that the decision to give more fluid or add inotropes to the resuscitation should be based on the entire clinical picture. In some patients, reaching higher or lower values than these targets may be associated with better hemodynamics, but deviation from these should be justified. Institutions that can bring more advanced technologies to the bedside may do so and use those measurements as part of the total clinical picture for decision making