We shall not cease from our exploration And at the end of all our exploring Will be to arrive where we started And know the place for the first time.
T.S. Eliot: Little Gidding (No. 4 of ‘Four Quartets’)
Oliveira and colleagues' randomised controlled trial of early goal-directed therapy (EGDT) for septic shock in children is intriguing . They report a 28-day survival benefit by targeting superior caval vein oxygen saturations (SCVO2) > 70% in addition to standard end-points in the immediate phase of resuscitation in septic shock. Control 28-day mortality was 39.2% vs. intervention group 11.8%, p = 0.002, a 70% relative risk reduction for death with a number needed to treat of 3.6. This is, by some distance, the greatest impact of any measure reported for paediatric sepsis. The authors rightly draw attention to the important caveat of the high control group mortality rate, meaning that care must be taken in applying these results to other settings.
This study is provocative, not just...
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