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Protocolised early goal-directed therapy in patients with sepsis/septic shock does not result in improved survival compared with usual care with less invasive resuscitation strategies
  1. Joel Meyer1,
  2. Manu Shankar-Hari1,2
  1. 1 Department of Critical Care Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
  2. 2 School of Immunology & Microbial Sciences, King’s College London, London, UK
  1. Correspondence to Dr Manu Shankar-Hari, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; manu.shankar-hari{at}

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Commentary on: Rowan KM, Angus DC, Bailey M, et al. Early, goal-directed therapy for septic shock – a patient-level meta-analysis. N Engl J Med 2017;376:2223–34.


Early goal-directed therapy for sepsis/septic shock became the standard of care as advocated by the 2004 Surviving Sepsis Campaign Guidelines.1 This guidance was based on a single-centre randomised controlled trial (RCT) by Rivers et al 2 involving 263 patients with sepsis/septic shock admitted to emergency departments. However, three recent multicentre, early goal-directed therapy RCTs3–5 were unable to replicate the treatment effects observed by Rivers et al.2 The current Surviving Sepsis Campaign Guidelines revised the resuscitation recommendations to administering at least 30 mL/kg of intravenous crystalloids in the first 3 hours of sepsis management. …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.