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The ProCESS, ARISE and ProMISe randomized trials collectively challenged the idea that protocolized early goal-directed therapy with mandatory central venous oxygen saturation targets is necessary for all patients with septic shock. Across contemporary trial settings, EGDT did not improve mortality compared with usual contemporary resuscitation, which already included rapid antibiotics, fluid therapy, vasopressors and close monitoring. The practical consequence is important: sepsis care should focus on timely recognition and physiologically appropriate resuscitation rather than rigid adherence to a single bundle of invasive targets. For internists, repeated clinical reassessment remains central. Fluid responsiveness, perfusion, lactate trends, urine output, capillary refill and bedside ultrasound can all contribute to a more individualized strategy. The trials do not justify therapeutic delay or undertreatment; they support flexible protocols that adapt to the patient rather than forcing every patient into the same algorithm.
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The ProCESS, ARISE and ProMISe randomized trials collectively challenged the idea that protocolized early goal-directed therapy with mandatory central venous oxygen saturation targets is necessary for all patients with septic shock. Across contemporary trial settings, EGDT did not improve mortality compared with usual contemporary resuscitation, which already included rapid antibiotics, fluid therapy, vasopressors and close monitoring. The practical consequence is important: sepsis care should focus on timely recognition and physiologically appropriate resuscitation rather than rigid adherence to a single bundle of invasive targets. For internists, repeated clinical reassessment remains central. Fluid responsiveness, perfusion, lactate trends, urine output, capillary refill and bedside ultrasound can all contribute to a more individualized strategy. The trials do not justify therapeutic delay or undertreatment; they support flexible protocols that adapt to the patient rather than forcing every patient into the same algorithm.
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