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).

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Title: 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: Leone M; Department of Anesthesiology and Intensive Care Medicine, Nord Hospital, Assistance Publique Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France. marc.leone@ap-hm.fr., Myatra SN; Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India., Dugar S; Department of Critical Care Medicine, Integrated Hospital-Care Institute (IHI), Cleveland Clinic, Cleveland, OH, USA.; Department of Medicine, Case Western Reserve University, Cleveland, OH, USA., Wieruszewski PM; Department of Anesthesiology, Mayo Clinic, and Department of Pharmacy, Mayo Clinic, Rochester, MN, USA., Russell L; Department of Intensive Care, Copenhagen University Hospital Gentofte, Hellerup, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark., Evans L; Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington Medical Center, Seattle, WA, USA., Delamarre L; Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, Gui De Chauliac, Montpellier, France., Sharif S; Divisions of Emergency Medicine and Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada.; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada., Chew MS; Perioperative Medicine and Intensive Care, Karolinska University Hospital Huddinge and Division of Anesthesiology and Intensive Care CLINTEC, Karolinska Institute, Stockholm, Sweden., Gong MN; Division of Critical Care Medicine, Division of Pulmonary Medicine, Department of Medicine, Epidemiology and Population Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA., Hernández G; Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile., Schorr C; Cooper University Hospital, Cooper Research Institute, Critical Care, Camden, NJ, USA., Lakbar I; Anesthesiology and Intensive Care, Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, INSERM U1046, 1, University of Montpellier, Montpellier, France., Smith SE; Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Athens, GA, USA., Martin-Loeches I; Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organisation (MICRO), Trinity College Dublin, St James's Hospital, Dublin, Ireland., Annane D; Service de Réanimation, Comprehensive Sepsis Centre PROMETHEUS, Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Université Versailles Saint-Quentin, Garches, Versailles, France., Balik M; Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic., Cecconi M; Biomedical Sciences Department, Humanitas University, Pieve Emanuele, Milan, Italy.; Department of Anaesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Italy., De Backer D; Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium., Donadello K; Department of Surgery, Anaesthesia and Intensive Care Unit B, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy.; Anaesthesia and Intensive Care Unit B, University Hospital Integrated Trust of Verona, Verona, Italy., Dünser MW; Department of Anesthesiology and Intensive Care Medicine, Kepler University Hospital, Johannes Kepler University, Linz, Austria., Einav S; Faculty of Medicine, Maccabi Healthcare System and Hebrew University, Jerusalem, Israel., Ferrer R; Intensive Care Department, Hospital Universitari Vall d'Hebron, Barcelona Autonomous University, Barcelona, Spain., Juffermans N; Intensive Care Unit, Erasmus Medical Center, Rotterdam, the Netherlands., Hamzaoui O; Unité de Médecine Intensive et Réanimation Polyvalente, Unité PPF 'Pharmacologie et Pathologies Fragilisantes'-UR 3801, CHU Reims, Université de Reims Champagne-Ardenne, Reims, France., Landoni G; Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy., Levy B; Médecine Intensive et Réanimation, CHRU Nancy, Pôle Cardio-Médico-Chirurgical, Vandoeuvre-Les-Nancy, France.; Faculté de Médecine, INSERM U1116, Vandoeuvre-Les-Nancy, France.; Université de Lorraine, Nancy, France., McKenzie C; Biomedical Research Centre, Perioperative and Critical Care Theme, National Institute of Health and Social Care Research, University of Southampton, Southampton, UK., Monnet X; Service de Médecine Intensive-Réanimation, Groupe de Recherche Clinique CARMAS, AP-HP, Hôpital de Bicêtre, DMU CORREVE, Inserm UMR S_999, Comprehensive Sepsis Centre, Université Paris-Saclay, Le Kremlin-Bicêtre, France., Ostermann M; Department of Intensive Care, King's College London, Guy's & St Thomas' Hospital, London, UK., Spies C; Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany., Singer M; Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, UK., Theodorakopulou M; Intensive Care Unit, General Hospital of Athens 'KAT', Athens, Greece., Topeli A; Department of Internal Medicine, Division of Intensive Care, Sepsis Research, Education and Practice Center, Hacettepe University Faculty of Medicine, Ankara, Turkey., Barreto E; Department of Pharmacy, Mayo Clinic, Rochester, MN, USA., Bauer SR; Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA., Busse LW; Department of Medicine, Emory Critical Care Center, Emory Healthcare, Emory University School of Medicine, Atlanta, GA, USA., Coopersmith CM; Department of Surgery and Emory Critical Care Center, Emory University, Atlanta, GA, USA., Deutschman C; Cohen Children's Medical Center, The Zucker School of Medicine at Northwell/Hofstra, The Feinstein Institute for Medical Research, Manhasset, NY, USA., Holder AL; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University, Atlanta, GA, USA., Kamaleswaran R; Department of Biomedical Engineering and Electrical and Computer Engineering, Duke University, Durham, NC, USA., Legrand M; Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA., Martin GS; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University, Atlanta, GA, USA., Maves RC; Division of Critical Care Medicine, Department of Anesthesiology, Division of Infectious Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA., Nazer L; King Hussein Cancer Center, Amman, Jordan., Nunnally ME; Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Langone Health, New York, NY, USA., Prescott HC; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ann Arbor, MI, USA.; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.; Veterans Affairs Center for Clinical Management Research, HSR Center of Innovation, Ann Arbor, MI, USA., Rincon T; Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, MA, USA.; Young School of Nursing, Regis College, Weston, MA, USA.; Department of Clinical Services, PreBorn!, Indianapolis, IN, USA., Sacha GL; Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA., Seymour CW; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA., Arabi YM; Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.; King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia., Besen BAMP; Intensive Care Department, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.; D'Or Institute for Research and Education, São Paulo, SP, Brazil., Cavalcanti AB; Division of Anesthesiology. Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil.; HCor Research Institute, São Paulo, Brazil., Deane AM; Department of Critical Care, Melbourne Medical School, & Intensive Care Unit, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia., Finfer S; The George Institute for Global Health, University of New South Wales, Sydney, Australia.; Faculty of Health, Imperial College London, London, UK., Hammond N; The George Institute for Global Health, University of New South Wales, Sydney, Australia.; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia., Ibarra-Estrada M; Department of Intensive Care Unit, Hospital Civil Fray Antonio Alcalde, Guadalajara, Jalisco, México., Kattan E; Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile., Kotani Y; Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Japan., Machado FR; Intensive Care Department, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil., Ospina-Tascón GA; Department of Intensive Care, Fundación Valle del Lili, Cali, Colombia.; Translational Research Laboratory in Critical Care Medicine (TransLab-CCM), Universidad Icesi, Cali, Colombia., Mer M; Department of Medicine, Divisions of Critical Care and Pulmonology, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa., Young PJ; Intensive Care Unit, Wellington Hospital, Wellington, New Zealand.; Medical Research Institute of New Zealand, Wellington, New Zealand., Rochwerg B; Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada.; Health Research Methods, Evidence, and Impact, Department of Medicine, McMaster University, Hamilton, ON, Canada., Khanna AK; Department of Anesthesiology, Division of Critical Care Medicine, Atrium Health Wake Forest Baptist Medical Center, Wake Forest School of Medicine, Winston-Salem, NC, USA.; Perioperative Outcomes and Informatics Collaborative, Winston-Salem, NC, USA.; Outcomes Research Consortium, Houston, TX, USA.
Source: Intensive care medicine [Intensive Care Med] 2026 May; Vol. 52 (5), pp. 984-1000. Date of Electronic Publication: 2026 Mar 24.
Publication Type: Journal Article; Consensus Statement
Journal Info: Publisher: Springer Verlag Country of Publication: United States NLM ID: 7704851 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-1238 (Electronic) Linking ISSN: 03424642 NLM ISO Abbreviation: Intensive Care Med Subsets: MEDLINE
Database: MEDLINE Ultimate
Description
ISSN:1432-1238
DOI:10.1007/s00134-026-08344-2