Consensus statement on the definition, diagnostic criteria, and treatment of refractory septic shock using a Delphi methodology.

Refractory septic shock is a critical condition within the spectrum of sepsis, characterized by an inadequate response to standard hemodynamic resuscitation. In the absence of a consensus operational definition, a consensus study was conducted using the Delphi methodology. Thirty experts in sepsis and hemodynamics participated. Statements related to the definition, diagnostic criteria, and therapy strategies for RSS were evaluated. Consensus was reached on 23 of 28 statements, allowing RSS to be defined as a clinical entity characterized by persistent hypotension and signs of global hypoperfusion for more than one hour, despite optimized initial treatment. Consensus was reached on the use of hydrocortisone, the inclusion of elevated lactate as a marker of hypoperfusion, the utility of advanced hemodynamic monitoring and echocardiography, and general recommendations on the use of combined vasopressors were evaluated. This study lays the groundwork for future research and clinical algorithms.