Our findings agree with those of the ProCESS trial,10 in which investigators also used a resuscitation algorithm that was similar to that used in the original EGDT trial.11 Although our results differ from those in the original trial, they are consistent with previous studies showing that bias in small, single-center trials may lead to inflated effect sizes34 that cannot be replicated in larger, multicenter studies.35-37 Although the ProCESS study did not directly compare protocol-
based EGDT for resuscitation with care that was not protocol-based, the concordance of results between our study and the ProCESS study suggests that EGDT does not offer a survival advantage in patients presenting to the emergency
department with early septic shock. Whether resuscitation protocols with different goals or different individual therapies in the EGDT bundle offer a survival benefit remains to be determined.