The usual suspects : a pragmatic framework to identify and address reversible contributors in apparent refractory septic shock
A subset of patients with septic shock remains hypoperfused or requires escalating vasopressor support despite initial resuscitation. Although this pattern may suggest progression toward refractory septic shock, early high vasopressor requirements or persistent hypoperfusion may still reflect potentially modifiable contributors, including unresolved infection, inadequate fluid administration, metabolic derangements, iatrogenic factors, or cardiac dysfunction. The recent SCCM/ESICM consensus provides expert-derived criteria for refractory septic shock, but the preceding bedside process of reassessing potentially reversible contributors remains less explicitly operationalized.
