Early, Goal-Directed Resuscitation for Septic Shock

To the Editor: The Protocolised Management in Sepsis (ProMISe) trial (April 2 issue) 1 completes a trio of studies 1 – 3 that question the further application of early, goal-directed therapy (EGDT) as suggested by Rivers et al. 4 In particular, these trials consistently show no survival benefit with regard to the mandated use of central venous oxygen saturation (ScvO 2 ) monitoring. However, it remains questionable whether the results of the three trials support this claim. According to the EGDT protocol, an ScvO 2 value of less than 70% is a trigger for hemodynamic intervention. Unlike in the study by Rivers et al., . . .