2)resuscitation strategieswere heterogeneous over time andlocation in the study of Kumar et al,whereas a single, algorithmic hemodynamicoptimization strategy initiated inthe ED was used in all patients in ourstudy; and 3) the study of Kumar et albenefited from a much larger samplesize.Results of animal studies using anintra-abdominal sepsis model suggest criticalinflection point between 12 and15 hrs after induction of septic shock;this inflection point coincides with theonset of persistent hypotension and thedevelopment of significant lactic acidosis.