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)

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 micrograms per kilogram per minute, and undergo CCUS assessment when mixed shock is suspected.

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Publication Details

Journal
Critical Care Medicine
Published
2026-03-24
DOI
https://doi.org/10.1097/ccm.0000000000007124
Primary Topic
Sepsis Diagnosis and Treatment
Type
article
Field-Weighted Citation Impact
0.00
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article

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)

Critical Care Medicine
Sepsis Diagnosis and Treatment
article

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)

article en

Abstract

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 micrograms per kilogram per minute, and undergo CCUS assessment when mixed shock is suspected.

Critical Care Medicine
Regis College (US), University of Verona (IT), Universitat Autònoma de Barcelona (ES), University of Copenhagen (DK), Atrium Health Wake Forest Baptist (US), Albert Einstein College of Medicine (US), Cleveland Clinic (US), The Royal Melbourne Hospital (AU), Université Libre de Bruxelles (BE), St Thomas' Hospital (GB), Feinstein Institute for Medical Research (US), Emory Healthcare (US), Mayo Clinic (US), Karolinska University Hospital (SE), Montefiore Medical Center (US), Humanitas University (IT), Georgia College & State University (US), Emory University (US), Vita-Salute San Raffaele University (IT), Inserm (FR), Pontificia Universidad Católica de Chile (CL), Outcomes Research Consortium (US), University of Georgia (US), University of Massachusetts Chan Medical School (US), University of Pittsburgh (US), Duke University (US), University of California, San Francisco (US), King's College London (GB), King Saud bin Abdulaziz University for Health Sciences (SA), University of the Witwatersrand (ZA), Université de Versailles Saint-Quentin-en-Yvelines (FR), Hebrew University of Jerusalem (IL), Homi Bhabha National Institute (IN), Charles University (CZ), Aix-Marseille Université (FR), Université Paris-Saclay (FR), University of Michigan (US), King Hussein Cancer Center (JO), Johannesburg Hospital (ZA), Royal North Shore Hospital (AU), Tata Memorial Hospital (IN), Cooper University Hospital (US), Wellington Hospital (NZ), University of Washington Medical Center (US), Erasmus MC (NL), Bury College (GB), Gentofte Hospital (DK), Maccabi Healthcare Services (IL), UNSW Sydney (AU), Humboldt-Universität zu Berlin (DE), NYU Langone Health (US), Centre Hospitalier Universitaire de Montpellier (FR), King Abdullah International Medical Research Center (SA), Fundación Valle del Lili (CO), D’Or Institute for Research and Education (BR), NIHR Imperial Biomedical Research Centre (GB), Family and Social Services Administration (US), The George Institute for Global Health (AU), Hôpital Gui de Chauliac (FR), Kameda Medical Center (JP), Michigan Medicine (US), VA Center for Clinical Management Research (US), Collaborative Group (United States) (US), NIHR Southampton Biomedical Research Centre (GB), Hospital Civil de Guadalajara (MX), Mayo Clinic in Arizona (US), Vall d'Hebron Hospital Universitari (ES), Princess Margaret Hospital (HK), Centre de Médecine Préventive (FR), Hôpital Raymond-Poincaré (FR), Medical Research Institute of New Zealand (NZ), Centre Hospitalier Interrégional Edith Cavell (BE), Hôpital Saint Eloi (FR), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (BR), Mayo Clinic in Florida (US), KAT General Hospital of Attica (GR), Istituti di Ricovero e Cura a Carattere Scientifico (IT), St. James's Hospital (IE), Impact (CA), Hospital São Paulo (BR), Bicêtre Hospital (FR), IRCCS Humanitas Research Hospital (IT), Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele (IT), University College London (GB), National Guard Health Affairs (SA), Wake Forest University (US), Imperial College London (GB), Case Western Reserve University (US), Hacettepe University (TR), Icesi University (CO), Universidade Federal de São Paulo (BR), Université de Lorraine (FR), Université de Reims Champagne-Ardenne (FR), McMaster University (CA)
Good health and well-being
Openalex Percentile: Top 12%
Sepsis Diagnosis and Treatment
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