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)
Authors' conclusion
A consensus for 13 criteria to frame the definition of refractory septic shock was reached.
Study context
- Population
- Multinational, multiprofessional and multidisciplinary critical care experts assembled by the SCCM and ESICM57 invitations
- Participants
- 56 participants
- Outcome
- Consensus on clinical criteria for refractory septic shock
Methodological detailsliterature review, expert panel position statements, five-round Delphi process, international expert group
- Literature review
- Expert panel position statements
- Five-round Delphi process
- International expert group
Recommendations
As reported in the abstract
- Statements proposed by steering committee
- 34
- Statements rejected after round 2
- 5
- Statements (from 8 domains) reaching consensus, of 29
- 13
- Markers of organ dysfunction (agreement, 2 rounds)
- 75%
- Tissue perfusion (agreement, 2 rounds)
- 91.1%
- Lactate (agreement, 2 rounds)
- 94.6%
- Capillary refill time (agreement, 2 rounds)
- 76.8%
- Assessment of fluid-responsiveness after initial resuscitation (agreement, 5 rounds)
- 92.9%
- Vasoactive drugs at norepinephrine equivalents >0.5 µg/kg/min (agreement, 3 rounds)
- 75.0%
- Critical care ultrasound, the single diagnostic modality reaching consensus (agreement, 3 rounds)
- 92.9%
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
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). Crit Care Med. Published 24 March 2026. doi:10.
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