Refractory Septic Shock and Alternative Wordings: A Systematic Review of Literature

Authors

Elio Antonucci, Intermediate Care Unit, Emergency Department, Ospedale Guglielmo da Saliceto, Piacenza, Italy.
Tania Polo, Intermediate Care Unit, Emergency Department, Ospedale Guglielmo da Saliceto, Piacenza, Italy.
Manuela Giovini, Intermediate Care Unit, Emergency Department, Ospedale Guglielmo da Saliceto, Piacenza, Italy.
Massimo Girardis, Department of Anesthesiology and Intensive Care, University Hospital of Modena, Modena, Italy.
Ignacio Martin-Loeches, Intensive Care Unit, Trinity Centre for Health Science HRB-Wellcome Trust, St James's Hospital, Dublin, Ireland.
Nathan D. Nielsen, Division of Pulmonary, Critical Care and Sleep Medicine and Section of Transfusion Medicine and Therapeutic Pathology, University of New Mexico School of Medicine, Albuquerque, NM, USA.
Francisco José Chacón Lozsán, Critical Care Medicine, Central University of Venezuela. Anesthesia and Critical Care Medicine, Péterfy Sándor Hospital, Budapest, Hungary.
Ricard Ferrer, Intensive Care Department, Vall d'Hebron University Hospital, Shock, organ dysfunction and Resuscitation Research Group (SODIR), VHIR, Barcelona, Spain.
Ines Lakbar, Department of anesthesiology and intensive care unit, North Hospital, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Marseille, France.
Marc Leone, Department of anesthesiology and intensive care unit, North Hospital, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Marseille, France.Follow

Document Type

Article

Publication Date

6-1-2023

Abstract

BACKGROUND: We reviewed the different studies using the terms "refractory septic shock" and/or "catecholamine resistance" and/or "high dose norepinephrine" so as to highlight the heterogeneity of the definitions used by authors addressing such concepts.

METHOD: A systematic review was conducted assessing the papers reporting data on refractory septic shock. We used keywords as exact phrases and subject headings according to database syntax.

RESULTS: Of 276 papers initially reviewed, we included 8 studies - 3 randomized controlled trials, 3 prospective studies and 2 retrospective studies, representing a total of 562 patients with septic shock. Catecholamine resistance was generally defined as "a decreased vascular responsiveness to catecholamine independently of the administered norepinephrine dose". Refractory septic shock was broadly defined as "a clinical condition characterized by persistent hyperdynamic shock even though adequate fluid resuscitation (individualized doses) and high doses of norepinephrine (≥ 1 μg/kg/min)". Reported "high doses" of norepinephrine were often ≥1 μg/kg/min. However, wide variability was found throughout the literature on the use of these terms.

DISCUSSION: Marked inconsistencies were identified in the usage of the terms for refractory septic shock. There is a pressing need to determine consensus definitions so as to establish a common language in the medical literature and to harmonize future studies.

Recommended Citation

Antonucci E, Polo T, Giovini M, Girardis M, Martin-Loeches I, Nielsen ND, Lozsán FJC, Ferrer R, Lakbar I, Leone M. Refractory septic shock and alternative wordings: A systematic review of literature. J Crit Care. 2023 Jun;75:154258. doi: 10.1016/j.jcrc.2023.154258. Epub 2023 Jan 25. PMID: 36706554.