Results
We enrolled 1260 patients, with 630 assigned to EGDT and 630 to usual care. By
90 days, 184 of 623 patients (29.5%) in the EGDT group and 181 of 620 patients
(29.2%) in the usual-care group had died (relative risk in the EGDT group, 1.01;
95% confidence interval [CI], 0.85 to 1.20; P = 0.90), for an absolute risk reduction
in the EGDT group of −0.3 percentage points (95% CI, −5.4 to 4.7). Increased treatment
intensity in the EGDT group was indicated by increased use of intravenous
fluids, vasoactive drugs, and red-cell transfusions and reflected by significantly
worse organ-failure scores, more days receiving advanced cardiovascular support,
and longer stays in the intensive care unit. There were no significant differences in
any other secondary outcomes, including health-related quality of life, or in rates of
serious adverse events. On average, EGDT increased costs, and the probability that
it was cost-effective was below 20%.