***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: Introduction Early structured resuscitation of severe sepsis has been suggested to improve short term mortality ; however , no previous study has examined the long-term effect of this therapy . We sought to determine one year outcomes associated with implementation of early goal directed therapy ( EGDT ) in the emergency department ( ED ) care of sepsis . Methods We performed a longitudinal analysis of a prospect i ve before and after study conducted at a large urban ED . Adult patients were enrolled if they had suspected infection , 2 or more systemic inflammatory response criteria , and either systolic blood pressure ( SBP ) < 90 mmHg after a fluid bolus or lactate > 4 mM. Exclusion criteria were : age < 18 years , no aggressive care desired , or need for immediate surgery . Clinical and outcomes data were prospect ively collected on consecutive eligible patients for 1 year before and 2 years after implementing EGDT . Patients in the pre-implementation phase received non- protocol ized care at attending physician discretion . The primary outcome was mortality at one year . Results 285 subjects , 79 in the pre- and 206 in the post-implementation phases , were enrolled . Compared to pre-implementation , post-implementation subjects had a significantly lower ED SBP ( 72 vs. 85 mm Hg , P < 0.001 ) and higher sequential organ failure assessment score ( 7 vs. 5 , P = 0.0004 ) . The primary outcome of 1 year mortality was observed in 39/79 ( 49 % ) pre-implementation subjects and 77/206 ( 37 % ) post-implementation subjects ( difference 12 % ; P = 0.04 ) . Conclusions Implementation of EGDT for the treatment of ED patients with severe sepsis and septic shock was associated with significantly lower mortality at one year 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 . ) ABSTRACT Protocol ized hemodynamic resuscitation in severe sepsis or septic shock is not universally applied in all emergency departments and general hospital wards around the world . It is unknown whether ScvO2 levels are associated with the clinical outcome of severe sepsis or septic shock under non protocol ized resuscitation . In this prospect i ve study , we enrolled 124 noncirrhotic patients who were admitted to intensive care units for severe sepsis or septic shock . The average Acute Physiology and Chronic Health Evaluation II score was 25.3 ( SD , 7.6 ) . According to ScvO2 levels after initial resuscitation before intensive care unit admission , patients were divided into high ( ScvO2 ≥ 70 % , n = 63 ) and low ( ScvO2 < 70 % , n = 61 ) ScvO2 groups . Compared with high ScvO2 groups , low ScvO2 groups showed no significant differences in 28-day mortality ( 25.4 % vs. 24.6 % ; P = 0.943 ) or hospital mortality ( 30.2 % vs. 31.1 % ; P = 0.794 ) . Multivariate logistic regression models showed that low mean arterial pressure ( hazard ratio , 0.967 ; 95 % confidence interval , 0.940–0.994 ; P = 0.019 ) and high central venous pressure ( hazard ratio , 1.150 ; 95 % confidence interval , 1.057–1.251 ; P = 0.001 ) after initial resuscitation were associated with higher 28-day mortality . On the contrary , ScvO2 levels after resuscitation were not related to 28-day or hospital mortality . In conclusion , our results showed that mean arterial pressure and central venous pressure were still the most important hemodynamic variables in initial hemodynamic resuscitation . Low postresuscitation ScvO2 was not associated with a worse outcome . It is possible that ScvO2 less than 70 % might not necessarily be associated with tissue hypoxia , and critical ScvO2 levels require to be determined by further studies 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 
    Output:
    
Conclusions EGDT was not associated with a survival benefit among patients with severe sepsis or septic shock .
Instead , EGDT was associated with a higher mortality rate in comparison to the early lactate clearance group .