 Background: ACCMPALS guidelines addresses early correction of pediatric septic shock using physical examination supplemented by indirect measures of cardiac output such as central venous or superior vena cava oxygen saturation ScvO270 in a goal directed approach. However, these endpoints are based on unsupported evidence. The purpose of this study was to compare ACCMPALS guidelines performed with and without ScvO2 on the morbidity and mortality rate of children with severe sepsis and septic shock. 