2)resuscitation strategies were heterogeneous over time and location in the study of Kumar et al,whereas a single, algorithmic hemodynamic optimization strategy initiated in the ED was used in all patients in our study; and 3) the study of Kumar et al benefited from a much larger sample size.Results of animal studies using anintra-abdominal sepsis model suggest critical inflection point between 12 and 15 hrs after induction of septic shock;this inflection point coincides with the onset of persistent hypotension and the development of significant lactic acidosis.