Australasian Resuscitation In Sepsis Evaluation Randomised Controlled Trial

Inclusion Criteria: * Suspected or confirmed infection * The presence of TWO or MORE of the following SIRS criteria: * Core temperature \< 36.0 degC or \> 38.0 degC * Heart rate \> 90 beats/minute * Respiratory rate \> 20 breaths/minute or PaCO2 \< 32 mmHg or the requirement for mechanical ventilation for an acute process * White blood cell count \> 12.0 or \< 4.0 x109/L or \> 10% immature band forms * Evidence of either refractory hypotension OR hypoperfusion: * Refractory hypotension is confirmed by the presence of a systolic blood pressure (SBP) \< 90 mmHg or mean arterial pressure (MAP) \< 65 mmHg after a 1000ml intravenous (IV) fluid challenge within 60 minutes (including IV fluids administered pre-hospital) * Hypoperfusion is confirmed by the presence of a blood lactate concentration greater than or equal to 4.0 mmol/L * First dose of IV antimicrobial therapy commenced prior to randomisation Exclusion Criteria: * Age \< 18 years * Contra-indication to superior vena cava (SVC) CVC insertion * Contra-indication to blood products (e.g. Jehovah's Witness) * Inability to commence delivery of the EGDT protocol within 1 hour of randomisation or complete 6 hours of EGDT * Haemodynamic instability due to active bleeding * Pregnancy (confirmed or suspected) * In-patient transfer from another acute health care facility * An underlying disease process with a life expectancy of \< 90 days * Death is deemed imminent and inevitable * A "limitation of therapy" order has been documented restricting implementation of the study protocol or the treating clinician deems aggressive care unsuitable