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In 2001, a single-center randomized trial demonstrated a significant mortality benefit for early goal-directed therapy (EGDT) in patients with septic shock (NEJM JW Gen Med Dec 15 2001 and N Engl J Med 2001; 345;1368). EGDT has been incorporated into guidelines (e.g., Surviving Sepsis) despite persistent skepticism. Two randomized, controlled, multicenter trials — ProCESS (NEJM JW Gen Med Apr 15 2014 and N Engl J Med 2014 Mar 18 [e-pub]) and ARISE (NEJM JW Gen Med Nov 1 2014 and N Engl J Med 2014 Oct 1 [e-pub]), published in 2014 — demonstrated no benefit for EGDT over usual care for patients with septic shock.
In a third large study of EGDT, investigators randomized 1260 English patients with severe sepsis or septic shock to EGDT or usual c…