Insights Into the Pathophysiology of Catecholamine-Refractory Shock: A Narrative Review

Shock, characterized by severe hemodynamic failure and tissue hypoperfusion, is a life-threatening condition that requires immediate recognition and adequate treatment. Some patients exhibit a poor response to catecholamines, progressing to refractory shock, and have a high mortality risk. We aimed to review the characteristics of patients associated with the development of refractory shock and to evaluate proposed strategies for improving prognosis. Refractory shock remains poorly defined due to unclear pathophysiology. The failure of mitochondria to produce energy, neurohormonal dysregulation, adrenergic receptor desensitisation, and inflammatory vasodilation all contribute to this condition. Prompt recognition of at-risk patients is essential and may be supported by clinical signs, vasopressor load, and biomarkers such as lactate and base excess. Multimodal strategies, which combine vasopressors with complementary mechanisms, corticosteroids, and metabolic support, present a promising approach to enhance outcomes. Further research is required to refine shock phenotyping and guide personalised therapy.