The Rivers trial was a small, single centre trial. It was widely accepted because it fitted with our preconceived notions of what good resuscitation involved. More recent evidence (Randomised Trial of Protocol-based care for Early Septic Shock NEJM 2014, the ProCESS trial) suggests that there is no difference between the Rivers protocol, and alternative less invasive protocol and usual care.

Overall, we should be aiming for:

Early recognition of sepsis.

Diagnosis and identification of source and pathogen.

Source control.

Appropriate antibiotics.

Fluid resuscitation aimed at reversing or stabilising physiological decline.