Related Experiment Video
Updated: Jan 13, 2026
05:56
A Reproducible Intensive Care Unit-Oriented Endotoxin Model in Rats
Published on: February 20, 2021
2.5K
Refractory septic shock: our updated pragmatic approach.
Filippo Palmesino1, Adam Woodman-Bailey1, Fraser Hanks1,2
1Department of Critical Care, Guy's and St Thomas' NHS Trust, London, SE1 7EH, UK.
Journal of Anesthesia, Analgesia and Critical Care
|January 9, 2026
Summary
Refractory septic shock patients often have poor outcomes. This study proposes an inexpensive, early multimodal therapy approach to reduce reliance on high-dose vasopressors and improve septic shock management.
Area of Science:
- Critical Care Medicine
- Sepsis Research
- Pharmacology
Background:
- Septic shock management has improved, yet a subset of patients develop refractory septic shock.
- This refractory group experiences high morbidity and mortality.
- Current clinical trials underrepresent these patients due to heterogeneity and logistical challenges.
Purpose of the Study:
- To present an updated, pragmatic, and cost-effective clinical approach for managing refractory septic shock.
- To reduce the detrimental effects of high-dose vasopressors in septic shock patients.
- To optimize treatment strategies for non-responsive septic shock cases.
Main Methods:
- Implementation of an early multimodal therapeutic strategy in a specialist referral center.
- Focus on clinical practice integration for pragmatic application.
- Emphasis on cost-effectiveness and accessibility.
Main Results:
- The proposed approach aims to mitigate the need for escalating vasopressor doses.
- Early multimodal therapy is hypothesized to improve outcomes in refractory septic shock.
- Clinical practice data informs the proposed strategy.
Conclusions:
- An early multimodal therapy approach offers a pragmatic and inexpensive strategy for refractory septic shock.
- This approach seeks to minimize vasopressor-induced complications.
- Further research should evaluate the efficacy of this strategy in diverse patient populations.
Keywords:
Catecholamine toxicityMulti-organ failureRefractory septic shockSeptic cardiomyopathyToxic shockVasoplegic shockMore Related Videos
Related Concept Videos
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
305
Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
305
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
639
Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
639
01:29Acute Respiratory Failure-V
448
The treatment for acute respiratory failure varies based on factors like the underlying cause, overall health, and severity. A collaborative healthcare team is essential for early detection, often through arterial blood gas analysis. Identifying the cause is the primary goal, with treatment strategies adjusted for ventilation/perfusion (V/Q) mismatch, shunting, or diffusion impairment.
Ensure that patients are monitored continuously for their response to therapy, including changes in...
Ensure that patients are monitored continuously for their response to therapy, including changes in...
448
01:28Pneumonia IV: Management
749
The treatment of pneumonia varies based on its severity and the causative pathogen. Here is a structured approach to managing pneumonia, integrating pharmaceutical and supportive care strategies.
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
749
01:27Acute Pyelonephritis I: Introduction
469
Pyelonephritis is a bacterial infection that primarily affects the renal parenchyma and collecting system, including the renal pelvis, tubules, and interstitial tissue of one or both kidneys. It can be classified as either acute—a sudden, severe infection—or chronic, which refers to long-term or recurrent kidney infections.The primary cause of acute pyelonephritis (APN) is bacterial infection, with Escherichia coli accounting for approximately 70-80% of cases. Other bacteria, such...
469
01:26Psychosis: Goals of Pharmacotherapy
460
Antipsychotic drugs are a crucial treatment method for acute and chronic psychoses, bipolar illness, and behavioral disorders. The selection of these drugs depends on several factors, including the state of the disease, clinical judgment, possible drug interactions, and the patient's sensitivity to adverse effects. In immediate scenarios, such as delirium and dementia, short-term treatment with low doses of high-potency typical or atypical agents can effectively manage symptom exacerbation.
460