Clinical Criteria for the Definition of Refractory Septic Shock

Document Overview

Document Title

Clinical Criteria for the Definition of Refractory Septic Shock

Authoring Societies

European Society of Intensive Care Medicine

Society of Critical Care Medicine

Document Publication Date

Mar 24, 2026

Page Last Reviewed/Updated

Jun 3, 2026

Document Type

Consensus Statement

Country of Publication

United States

Full Text Freely Available

Yes

Full Text Guideline

link.springer.com/article/10.1007/s00134-026-08344-2

Source Citation

Leone, Marc et al. “Clinical criteria for the definition of refractory septic shock: a joint Delphi consensus from the Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM).” Intensive care medicine, 10.1007/s00134-026-08344-2. 24 Mar. 2026, doi:10.1007/s00134-026-08344-2

Document Scope, Criteria, and Use Cases

Document Objectives

A definition of refractory septic shock is necessary to guide diagnosis, management, prognostication, research, and future guidelines for this most severe form of the disease. We sought to achieve consensus on clinical criteria that would be used to define refractory septic shock. A consensus for 13 criteria to frame the definition of refractory septic shock was reached. Refractory septic shock is characterised by persistently elevated lactate concentrations and or prolonged capillary refill time in patients with septic shock who are fluid unresponsive, require a norepinephrine base equivalent dose greater than 0.5 µg per kilogram per minute, and undergo CCUS assessment when mixed shock is suspected.

Scope

Assessment and Screening, Diagnosis

Diseases/Conditions (MeSH)

D012772 - Shock, Septic

Keywords

refractory septic shock, sepsis, septic shock

Inclusion Criteria

Male, Female, Adolescent, Adult, Child, Older Adult

Health Care Settings

Emergency Care, Hospital

Intended Users

Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Number of Source Documents

80

Literature Search Start Date

Saturday, January 1, 2000

Literature Search End Date

Tuesday, December 31, 2024

Includes public comment process?

No

Methodologist involvement?

Yes

Patient involvement?

No

Includes multi-disciplinary group?

Yes

Includes systematic review?

Yes

Grades quality of strength of evidence?

No

Grades quality of strength of recommendation?

No

Discloses funding source?

Yes

Discloses conflicts of interest?

Yes

Includes benefits/harms analysis with recommendations?

No