By 60 days , there were 92 deaths in the protocol-based EGDT group ( 21.0 % ) , 81 in the protocol-based standard-therapy group ( 18.2 % ) , and 86 in the usual-care group ( 18.9 % ) ( relative risk with protocol-based therapy vs. usual care , 1.04 ; 95 % confidence interval [ CI ] , 0.82 to 1.31 ; P = 0.83 ; relative risk with protocol-based EGDT vs. protocol-based standard therapy , 1.15 ; 95 % CI , 0.88 to 1.51 ; P = 0.31 ) .