Aims & Objectives: Early goal directed therapy improves septic shock outcomes, however data from India is scarce. We studied feasibility of achieving and maintaining ScvO2 based goal directed therapy (GDT) versus prevalent practice Methods:Design: Randomized Control Trial Setting: Tertiary care teaching institute Participants: Children (6 month-12 years) with fluid refractory septic shock. Inotrope at arrival, chronic illnesses and contraindications for central line were exclusions Interventions: GDT group (n=46) received fluids, inotrope and packed red cells targeting ScvO2 of >70%. Standard therapy (ST) (n=46) group received usual care as per prevalent unit practice Main Outcome Measures: Mortality; shock endpoints and ScvO2 trend Results: Baseline characteristics were comparable in the two groups. However, children with baseline ScvO2 <70% were more in GDT arm compared to ST arm [21/42(50%) vs 4/14(28%), p=0.22]. More children attained endpoints within 5-day intervention period in the ST group vs GDT group[31(67%) vs 24(52%) (p=0.13)]. Endpoints were attained earlier in GDT arm vs ST arm [median(IQR) 9 hrs (6,21) vs 12 hours (6,24) (p=0.42)]. Significantly more children died in the GDT arm [35(76.1%) vs 21(45.7%); p=0.03]. Figure 1 shows outcome of GDT patients based on their baseline and subsequent ScvO2.Conclusions: GDT patients were relatively sicker. ScvO2 monitoring helped in identifying children with lower baseline ScvO2 and those with inability to attain ScvO2 >70%. The latter ones had higher mortality. The median duration to attain endpoints in the studied clinical setting seems to be delayed compared to high income countries probably due to limitation of material and human resources.