The protocol proposed by Rivers and coworkers involves attainment of physiological levels of hemodynamic parameters (arterial blood pressure and central venous oxygen saturation [ScvO 2 ], by using fluid loading, vasopressors, packed red cells, and early initiation of mechanical ventilation) as rapidly as possible. The overwhelmingly positive results of this EGDT study prompted a number of ED and ICU teams to change their daily care in accordance with the study protocol. Some papers [62, [64] [65] [66] reported partial or absolute adherence to the procedures evaluated by Rivers and coworkers. Others proposed adapting the procedure to their medical system with either less aggressive therapy or by forming 'sepsis teams' specifically tasked with managing patients with severe infection [67] [68] [69] [70] [71] [72] . The overall result of these reports was a trend toward improved outcomes in septic patients [73] .