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)
Methodological detailsliterature review, expert panel position statements, five-round Delphi process, international multiprofessional expert panel, Consensus: ≥75% of panellists agreeing or disagreeing (7-point Likert scale or single/multiple-choice questions), 34 statements proposed; 5 rejected after round 2; consensus on 13 of 29 statements from 8 domains
- Literature review
- Expert panel position statements
- Five-round Delphi process
- International multiprofessional expert panel
- Consensus: ≥75% of panellists agreeing or disagreeing (7-point Likert scale or single/multiple-choice questions)
- 34 statements proposed; 5 rejected after round 2; consensus on 13 of 29 statements from 8 domains
Recommendations
As issued by the authors
- 75%, 2 rounds
Markers of organ dysfunction as a clinical criterion of refractory septic shock
- 91.1%, 2 rounds
Tissue perfusion as a clinical criterion of refractory septic shock
- 94.6%, 2 rounds
Lactate as a tissue perfusion criterion
- 76.8%, 2 rounds
Capillary refill time as a tissue perfusion criterion
- 92.9%, 5 rounds
Assessment of fluid responsiveness after initial resuscitation as a clinical criterion
- 75.0%, 3 rounds
Vasoactive drugs at norepinephrine equivalents >0.5 µg/kg/min as a clinical criterion
- 92.9%, 3 rounds
Critical care ultrasound (CCUS) as the single diagnostic modality reaching consensus
Original publication
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 Med. Published 24 March 2026. doi:10.
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