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Insights Into the Pathophysiology of Catecholamine-Refractory Shock: A Narrative Review
Ana Gonçalves1, Filipa Gonçalves Pereira2, Susana Fernandes2,3
1Intensive Care Unit Department, Hospital Vila Franca de Xira, Vila Franca de Xira, PRT.
Cureus
|July 18, 2025
Summary
Refractory shock, a severe condition with poor response to standard treatment, has unclear causes but involves mitochondrial dysfunction and inflammation. Multimodal therapies show promise for improving outcomes in these critical patients.
Area of Science:
- Critical Care Medicine
- Cardiovascular Physiology
- Pathophysiology
Background:
- Shock is a life-threatening condition requiring immediate medical attention.
- Refractory shock, characterized by poor response to catecholamines, carries a high mortality risk.
- The pathophysiology of refractory shock is not well-defined.
Purpose of the Study:
- To review patient characteristics associated with refractory shock development.
- To evaluate strategies for improving prognosis in refractory shock.
- To clarify the poorly defined nature of refractory shock.
Main Methods:
- Literature review of refractory shock characteristics.
- Analysis of proposed prognostic improvement strategies.
- Examination of contributing pathophysiological factors.
Main Results:
- Refractory shock pathophysiology involves mitochondrial energy failure, neurohormonal imbalance, receptor desensitization, and vasodilation.
- Early recognition using clinical signs, vasopressor load, lactate, and base excess is crucial.
- Multimodal strategies combining vasopressors, corticosteroids, and metabolic support are promising.
Conclusions:
- Prompt identification of refractory shock is essential for timely intervention.
- Multimodal therapeutic approaches offer a promising avenue for enhancing patient outcomes.
- Further research is needed to refine shock phenotyping and personalize treatment strategies.
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