The PROMISE trial; is this the end of EGDT???

Trial of Early, Goal-Directed Resuscitation for Septic Shock NEJM March 17 2015   Sepsis has been in the EM literature a lot over the past 12 months. The phenomenal reduction in mortality that Rivers Early Goal Directed Therapy (EGDT) demonstrated in 2001 has been variably implemented. He had demonstrated a NNT of 6 to save one life when implementing EGDT in severe sepsis or septic shock, it was however a small single center trial and many were skeptical of it’s external validity. The Surviving Sepsis Campaign has endorsed the implementation of EGDT. Despite this the implementation has not been widespread. In order to address concerns re the external validity of Rivers work the last 12 months has seen a trio of papers addressing the question;