Central Venous Pressure and fluid responsiveness

Since Rivers’s publication of Early Goal Directed Therapy (EGDT) at the turn of the century clinicians have talked about aggressive resuscitation for septic shock. One of the goals underpinning this technique is the insertion of a central line with targeted goals of CVP and central venous oxygen saturations. This model of care for patients with septic shock had an NNT of 6 to save a life which is pretty phenomenal! Try to think of another therapy that has been proven to have such a dramatic effect on patients…… So why is it that most of you reading this won’t have followed EGDT in your patients with septic shock? How heavily should this guilt be weighing on your shoulders?