Over the past 40 years there has been dramatic improvement in outcome from septic shock in children, with mortality reducing from 97% in the 1960s, 60% in the 1980s, to 9% in 1999. Changes in clinical practice have been based on case series, cohort studies and physiological experiments, rather than on evidence from randomised controlled trials. 6 There have also been significant changes to the organisation and delivery of health care, particularly in the provision of resuscitation and intensive care that have been associated with reduced mortality. The paucity of high quality randomised controlled trial (RCT) evidence for the protocols and practices.
