Introduction and Context
Refractory septic shock is the point at which ordinary sepsis care is no longer enough: blood pressure remains unstable, tissue perfusion stays poor, vasopressor needs climb, and organ failure can continue despite intensive treatment. Until now, however, there has been no universally accepted clinical definition. That gap has made it harder to compare patients, stratify risk, design trials, and decide when a patient has crossed into the most severe end of the septic shock spectrum.
The new joint Delphi consensus from the Society of Critical Care Medicine and the European Society of Intensive Care Medicine was created to solve that problem. Rather than asking whether refractory septic shock should exist as a concept, the panel asked a more practical question: what clinical criteria should define it at the bedside? The result is not a treatment guideline, but a consensus framework intended to standardize diagnosis, prognostication, and research enrollment.
