***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : The authors hypothesized that goal -directed hemodynamic therapy , based on the combination of functional and volumetric hemodynamic parameters , improves outcome in patients with cardiac surgery . Therefore , a therapy guided by stroke volume variation , individually optimized global end-diastolic volume index , cardiac index , and mean arterial pressure was compared with an algorithm based on mean arterial pressure and central venous pressure . Methods : This prospect i ve , controlled , parallel-arm , open-label trial r and omized 100 coronary artery bypass grafting and /or aortic valve replacement patients to a study group ( SG ; n = 50 ) or a control group ( CG ; n = 50 ) . In the SG , hemodynamic therapy was guided by stroke volume variation , optimized global end-diastolic volume index , mean arterial pressure , and cardiac index . Optimized global end-diastolic volume index was defined before and after weaning from cardiopulmonary bypass and at intensive care unit ( ICU ) admission . Mean arterial pressure and central venous pressure served as hemodynamic goals in the CG . Therapy was started immediately after induction of anesthesia and continued until ICU discharge criteria , serving as primary outcome parameter , were fulfilled . Results : Intraoperative need for norepinephrine was decreased in the SG with a mean ( ±SD ) of 9.0 ± 7.6 versus 14.9 ± 11.1 µg/kg ( P = 0.002 ) . Postoperative complications ( SG , 40 vs. CG , 63 ; P = 0.004 ) , time to reach ICU discharge criteria ( SG , 15 ± 6 h ; CG , 24 ± 29 h ; P < 0.001 ) , and length of ICU stay ( SG , 42 ± 19 h ; CG , 62 ± 58 h ; P = 0.018 ) were reduced in the SG . Conclusion : Early goal -directed hemodynamic therapy based on cardiac index , stroke volume variation , and optimized global end-diastolic volume index reduces complications and length of ICU stay after cardiac surgery OBJECTIVE To compare the efficacy of fluid resuscitation as guided by lactate clearance rate ( LCR ) and central venous oxygen saturation ( ScvO2 ) in patients with sepsis . METHODS A prospect i ve r and omized control study was conducted . Fifty patients diagnosed with severe sepsis or septic shock from January 2011 to February 2012 in department of critical care medicine of Fourth Hospital of Hebei Medical University were enrolled in the study . The patients were r and omly divided into two groups according to the sequence ( each n=25 ) : ScvO2 group and LCR group . After ICU admission , the patients were treated symptomatically timely , and fluid resuscitation was started as early as possible according to Surviving Sepsis Campaign guidance for management of severe sepsis and septic shock 2008 . Central venous pressure (CVP)≥8 mm Hg ( 1 mm Hg=0.133 kPa ) , mean arterial pressure (MAP)≥65 mm Hg and ScvO2≥0.70 served as goal values to accomplish the fluid resuscitation therapy in ScvO2 group , while CVP≥8 mm Hg , MAP≥65 mm Hg , LCR≥10 % served as goal value to accomplish the fluid resuscitation therapy in LCR group . The general condition and clinical characteristics on arrival in ICU , changes in CVP , MAP , ScvO2 , lactate level and /or LCR before ( 0 hour ) and 3 , 6 , 72 hours after the start of fluid resuscitation and the other related conditions during the therapy were recorded . RESULTS There was no significant difference in general data or clinical characteristics before the start of therapy , occurrence of organ dysfunction , or treatment measures during different time periods after start of fluid resuscitation . Compared with the condition immediately before fluid resuscitation , at 3 hours after start of fluid resuscitation , CVP were improved in LCR and ScvO2 groups ( 8.58±1.17 mm Hg vs. 6.33±1.21 mm Hg , 9.08±2.43 mm Hg vs. 5.33±0.98 mm Hg , both P<0.05 ) ; at 6 hours after start of fluid resuscitation , heart rate ( HR ) and respiratory rate ( RR ) were lowered in LCR and ScvO2 groups ( HR : 96±18 bpm vs. 127±13 bpm , 98±13 bpm vs. 116±19 bpm , RR : 23±3 times/min vs. 33±9 times/min , 24±5 times/min vs. 35±6 times/min , all P<0.05 ) , oxygenation index ( PaO2/FiO2 ) was increased in LCR and ScvO2 groups ( 179±41 mm Hg vs. 86±21 mm Hg , 202±33 mm Hg vs. 95±17 mm Hg , both P<0.05 ) , and there was no significant difference in MAP in both groups . There was no significant difference in all indexes between two groups . In LCR group , 3 hours after start of fluid resuscitation , lactate level was significantly decreased ( 2.81±0.18 mmol/L vs. 3.43±1.31 mmol/L , P<0.05 ) . Compared with the value 3 hours after start of fluid resuscitation , LCR was significantly improved at 6 hours and 72 hours after start of fluid resuscitation in LCR group [ (42.69±8.75)% , (48.87±9.69)% vs. (20.32±4.58)% , both P<0.05 ] . Compared with that immediately before fluid resuscitation , ScvO2 was significant improved in ScvO2 group at 3 hours after start of fluid resuscitation ( 0.65±0.04 vs. 0.53±0.06 , P<0.05 ) . There was no significant difference in success rate of fluid resuscitation comparing that of 6 hours and that of 72 hours [ 6 hours : 72 % ( 18/25 ) vs. 64 % ( 16/25 ) , χ(2)=0.368 , P=0.762 ; 72 hours : 88 % ( 22/25 ) vs. 88 % ( 22/25 ) , χ(2)=0.000 , P=1.000 ] , length of ICU stay ( 8±3 days vs. 10±4 days , t=0.533 , P=0.874 ) , length of hospital stay ( 29±11 days vs. 35±16 days , t=0.692 , P=0.531 ) , improvement rate [ 84 % ( 21/25 ) vs. 76%(19/25 ) , χ(2)=0.500 , P=0.480 ] or 28-day mortality [ 20 % ( 5/25 ) vs. 28 % ( 7/25 ) , χ(2)=0.439 , P=0.742 ] between LCR and ScvO2 groups . CONCLUSIONS Both LCR and ScvO2 can be taken as the index in confirming the endpoint of fluid resuscitation for patients with severe sepsis and septic shock . Fluid resuscitation therapy under the guidance of LCR is accurate and reliable in patients with severe sepsis and septic shock BACKGROUND In a single-center study published more than a decade ago involving patients presenting to the emergency department with severe sepsis and septic shock , mortality was markedly lower among those who were treated according to a 6-hour protocol of early goal -directed therapy ( EGDT )  , in which intravenous fluids , vasopressors , inotropes , and blood transfusions were adjusted to reach central hemodynamic targets , than among those receiving usual care . We conducted a trial to determine whether these findings were generalizable and whether all aspects of the protocol were necessary . METHODS In 31 emergency departments in the United States , we r and omly assigned patients with septic shock to one of three groups for 6 hours of resuscitation : protocol -based EGDT ; protocol -based st and ard therapy that did not require the placement of a central venous catheter , administration of inotropes , or blood transfusions ; or usual care . The primary end point was 60-day in-hospital mortality . We tested sequentially whether protocol -based care ( EGDT and st and ard-therapy groups combined ) was superior to usual care and whether protocol -based EGDT was superior to protocol -based st and ard therapy . Secondary outcomes included longer-term mortality and the need for organ support . RESULTS We enrolled 1341 patients , of whom 439 were r and omly assigned to protocol -based EGDT , 446 to protocol -based st and ard therapy , and 456 to usual care .  Resuscitation strategies differed significantly with respect to the monitoring of central venous pressure and oxygen and the use of intravenous fluids , vasopressors , inotropes , and blood transfusions . By 60 days , there were 92 deaths in the protocol -based EGDT group ( 21.0 % ) , 81 in the protocol -based st and ard-therapy group ( 18.2 % ) , and 86 in the usual-care group ( 18.9 % ) ( relative risk with protocol -based therapy vs. usual care , 1.04 ; 95 % confidence interval [ CI ] , 0.82 to 1.31 ; P=0.83 ; relative risk with protocol -based EGDT vs. protocol -based st and ard therapy , 1.15 ; 95 % CI , 0.88 to 1.51 ; P=0.31 ) . There were no significant differences in 90-day mortality , 1-year mortality , or the need for organ support . CONCLUSIONS In a multicenter trial conducted in the tertiary care setting , protocol -based resuscitation of patients in whom septic shock was diagnosed in the emergency department did not improve outcomes . ( Funded by the National Institute of General Medical Sciences ; ProCESS Clinical Trials.gov number , NCT00510835 . ) OBJECTIVE To evaluate the effects of increased oxygen delivery on mortality and morbidity . DESIGN R and omized , controlled trial . SETTING Medical-surgical ICU of a tertiary care hospital . PATIENTS Sixty-three patients classified according to predetermined criteria as having severe sepsis or septic shock . INTERVENTIONS The patients were r and omly assigned to one of two groups : the control group ( n = 32 ) received conventional therapy with a normal targeted value of oxygen delivery , and the treatment group ( n = 31 ) received therapy with a targeted oxygen delivery index ( DO2I ) value of > 600 mL/min/m2 . The therapeutic approach to maintain BP , arterial saturation , hemoglobin concentration , and pulmonary artery occlusion pressure was similar in both groups . MEASUREMENTS AND MAIN RESULTS The hemodynamic , oxygen transport , and gastric intramucosal pH measurements were recorded at the time of admission to the study and every 6 h for the next 96 h. The outcome measures were the rate of patient mortality and the number of organ dysfunctions occurring during the ICU stay . The study groups were similar with respect to demographics and admission hemodynamic variables , but the percentage of patients with positive blood cultures was significantly higher in the control group than in the treatment group , respectively : 34 vs 13 % ( p = 0.04 ) . The average cardiac index was significantly higher in the treatment group than in the control group , respectively : 3.96 vs 3.05 L/min/m2 ( p = 0.01 ) . This factor did not significantly affect the DO2I . Nine of the 31 treatment group patients reached an average DO2I value of > 600 mL/min/m2 . The rate of mortality in the control group patients up to the time of ICU discharge ( 66 % ) was similar to that seen in the treatment group ( 74 % ) , respectively : 21 of 32 vs 23 of 31 ( p = 0.46 ) . The number of dysfunctional organs per patient was also similar in the control and treatment groups , respectively : 2.1+/-1.1 vs 2.6+/-1.2 ( p = 0.12 ) . CONCLUSION Treatment aim ed at maximizing oxygen delivery in patients with severe sepsis or septic shock does not reduce mortality or morbidity Introduction Several single-center studies and meta-analyses have shown that perioperative goal -directed therapy may significantly improve outcomes in general surgical patients . We hypothesized that using a treatment algorithm based on pulse pressure variation , cardiac index trending by radial artery pulse contour analysis , and mean arterial pressure in a study group ( SG ) , would result in reduced complications , reduced length of hospital stay and quicker return of bowel movement postoperatively in abdominal surgical patients , when compared to a control group ( CG ) . Methods 160 patients undergoing elective major abdominal surgery were r and omized to the SG ( 79 patients ) or to the CG ( 81 patients ) . In the SG hemodynamic therapy was guided by pulse pressure variation , cardiac index trending and mean arterial pressure . In the CG hemodynamic therapy was performed at the discretion of the treating anesthesiologist . Outcome data were recorded up to 28 days postoperatively . Results The total number of complications was significantly lower in the SG ( 72 vs. 52 complications , p = 0.038 ) . In particular 
    Output:
    
The number of high quality trials evaluating the effect of protocol ized hemodynamic management directed towards a meaningful treatment goal in critically ill patients in comparison to st and ard of care treatment is too low to prove or exclude a reduction in mortality