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Critical Care977 papers

Sepsis without septic shock

Last edited: 4/23/2026

Overview

Sepsis without septic shock refers to systemic inflammatory response syndrome (SIRS) due to infection without persistent hypotension requiring vasopressors. It shares many clinical features with septic shock but lacks the severe hemodynamic instability characteristic of shock states. 2

Diagnosis

  • Presence of infection evidenced by clinical signs and/or positive cultures 2
  • Presence of at least two of the following: temperature >38°C or <36°C, heart rate >90 bpm, respiratory rate >20 breaths/min or PaCO2 <32 mmHg, white blood cell count >12,000/μL or <4,000/μL or >10% immature forms 2
  • Exclusion of other causes of organ dysfunction 2
  • Management

  • Fluid Resuscitation: Initial aggressive fluid administration to restore intravascular volume 2229
  • Vasopressors: Initiation if hypotension develops; norepinephrine is commonly used 60
  • Early Goal-Directed Therapy (EGDT): Focus on optimizing hemodynamics, oxygen delivery, and tissue perfusion 222
  • Adjunctive Therapies: Consideration of low-dose hydrocortisone in refractory cases 7
  • Source Control: Early identification and management of infectious source 2
  • Monitoring: Regular assessment of lactate levels, organ function, and fluid responsiveness 925
  • Special Populations

  • Pediatrics: Fluid resuscitation with balanced crystalloids recommended over saline 829
  • Elderly: Higher incidence of negative blood cultures in those on vasodilators; careful monitoring of fluid balance and hemodynamic stability 2
  • Comorbidities: Patients with heart failure may require closer monitoring of fluid status and cardiac function 2627
  • Key Recommendations

  • Initiate early fluid resuscitation to restore intravascular volume in sepsis without shock (Evidence: Strong 2229)
  • Use norepinephrine as the first-line vasopressor if hypotension develops (Evidence: Strong 60)
  • Consider low-dose hydrocortisone in patients with refractory septic symptoms (Evidence: Moderate 7)
  • Regularly monitor lactate levels and organ function to guide therapy (Evidence: Moderate 925)
  • Tailor fluid management in elderly patients, especially those on vasodilators, due to higher risk of negative cultures (Evidence: Moderate 2)
  • References

    Showing 100 most recent of 635 indexed papers.

    1 Mallmann C, Silva LOJ, Oliveira MS, Galiotto TMB, Nedel WL, Moraes RB. Effect of norepinephrine versus vasopressin weaning on incidence of hypotension in septic shock patients: a systematic review and meta-analysis. Critical care science 2026. link 2 Dumanis G, Vaisman A, Issawy M, Gilboa M, Landau Zenilman C, Itelman E et al.. Fever and hypotension vs. frank septic shock: Elderly patients taking vasodilators who present with fever and hypotension have a higher incidence of negative blood cultures. A retrospective analysis of 3,726 patients. The American journal of the medical sciences 2026. link 3 Hedia DSM, Mahmoud HO, AbdelFattah AM, AbdelSalam EH, Mahmoud OS. Hyperdynamic left ventricular ejection fraction as a predictor of mortality in intensive care unit patients with septic shock. Heart & lung : the journal of critical care 2026. link 4 Black LP, Hopson C, Puskarich MA, Modave F, McCarthy DM, DeVos E et al.. Time to Vasopressor Initiation Is Not Associated With Increased Mortality in Patients With Septic Shock. Annals of emergency medicine 2026. link 5 Hajeh H, Garcia-Pacheco R. A rare case of mal-positioning of an internal jugular central venous catheter due to an anomalous right upper pulmonary venous return. The journal of vascular access 2026. link 6 Liu QF, Ge L, Yao D, Huang XM, Li GC, Gong NJ. Time-Dependent Fluid Accumulation Index for Phase-Specific Risk Stratification in Septic Shock with Heart Failure. Current medical science 2026. link 7 Meersseman P, Hernández-Tejero M, Diaz JM, Wauters J, Hermans G, Aziz F et al.. Low-Dose Hydrocortisone in Cirrhotic Patients With Septic Shock: A Double-Blind Randomised Placebo-Controlled Trial. Liver international : official journal of the International Association for the Study of the Liver 2025. link 8 Vijendra B, Bertol AB, de Almeida MMG, de Freitas PHAG, Simão ÁMS, de Faria BL. Balanced crystalloid versus saline for resuscitation in pediatric septic shock: a systematic review and meta-analysis. BMC pediatrics 2025. link 9 Wang J, Blake LM, Orozco N, Fiorini K, McChesney C, Slessarev M et al.. Dynamic Measures of Fluid Responsiveness to Guide Resuscitation in Patients With Sepsis and Septic Shock: A Systematic Review and Meta-Analysis. Critical care explorations 2025. link 10 McDonald R, Burns M, Wong A, Smith C, Ostermann M, Hutchings S. The effects of vasopressor choice on renal outcomes in septic shock: a systematic review of randomised trials as a guide for future research. Critical care (London, England) 2025. link 11 Ng KT, Kwok PE, Lim WE, Teoh WY, Hasan MS, Zainal Abidin MF. The use of methylene blue in adult patients with septic shock: a systematic review and meta-analysis. Brazilian journal of anesthesiology (Elsevier) 2025. link 12 Bauer SR, Wieruszewski PM, Bissell Turpin BD, Dugar S, Sacha GL, Sato R et al.. ADJUNCTIVE VASOPRESSORS AND SHORT-TERM MORTALITY IN ADULTS WITH SEPTIC SHOCK: A SYSTEMATIC REVIEW AND META-ANALYSIS. Shock (Augusta, Ga.) 2025. link 13 Xu QY, Jin YH, Fu L, Li YY. Application of norepinephrine in the treatment of septic shock: a meta-analysis. Irish journal of medical science 2025. link 14 Ichwan D, Cannavino C, Harvey H, Lange A, Shah A. Serious Video Game for Teaching Pediatric Emergency Medicine: A Randomized Controlled Noninferiority Trial of a Serious Game Versus Traditional Simulation. Pediatric emergency care 2025. link 15 Yaghyazaryan A, Gracchi V, Zielhuis SWJ, Schölvinck EH, Touw DJ, Kneyber MCJ et al.. Effect of therapeutic plasma exchange on amoxicillin, clindamycin, midazolam, and morphine pharmacokinetics in a critically ill child. Pediatric nephrology (Berlin, Germany) 2025. link 16 Ruiz-Rodríguez JC, Chiscano-Camón L, Bajaña I, Ruiz-Sanmartin A, Bastidas J, Maldonado C et al.. Endotoxin hemoadsorption in refractory septic shock with multiorgan dysfunction and extreme endotoxin activity. Critical care (London, England) 2025. link 17 Humes HD, Luckritz K, Gorga S, Plomaritas K, Hoatlin S, Humes M et al.. Management dilemma in choosing evolving treatments in neutropenic septic shock. Pediatric nephrology (Berlin, Germany) 2025. link 18 Tanbour RG, Amer R, Matar AN, Aiesh BM. Acute infectious purpura fulminant due to Enterococcus faecium infection: a case report. Journal of medical case reports 2025. link 19 Molinari L, Tidswell MA, Al-Khafaji A, Davison D, Galphin C, Kamaluddin E et al.. Organ Failure, Endotoxin Activity, and Mortality in Septic Shock. Critical care explorations 2025. link 20 Tunctan B, Senol SP, Yilmaz DE, Bahceli O, Kara T, Ahmed-Reda Elosman M. Inhibition of the RIPK1-driven necroptotic pathway protects against hypotensive and tachycardic responses to LPS in a rat model of septic shock. Cellular and molecular biology (Noisy-le-Grand, France) 2025. link 21 Kotani Y, Lezzi M, Murru CP, Khanna AK, Zarbock A, Bellomo R et al.. The Efficacy and Safety of Angiotensin II for Treatment of Vasoplegia in Critically Ill Patients: A Systematic Review. Journal of cardiothoracic and vascular anesthesia 2025. link 22 Gu T, Min Y, Zhang L, Jin F, Liu F. Impact of 30 mL/kg fluid resuscitation completed within one hour on elderly septic shock patient. Annals of medicine 2025. link 23 Chilletti R, Ihle J, Butt W. Mechanical Circulatory Support for Septic Shock in Children and Adults: Different But Similar. The Canadian journal of cardiology 2025. link 24 Allam S, Na J, Moon J, Desai Y, Messner C, Potenza R et al.. Bleeding, stroke, and mortality risk of patients with septic shock receiving anticoagulation for atrial fibrillation. Heart rhythm 2025. link 25 Zou ZY, Gui SQ. The impact of early morphine administration on septic patients with pre-existing chronic heart failure. Clinics (Sao Paulo, Brazil) 2025. link 26 Yang HY, Jiang MH, Yu F, Yang LJ, Zhang X, Li DM et al.. Predicting survival rates of critically ill septic patients with heart failure using interpretable machine learning models. Technology and health care : official journal of the European Society for Engineering and Medicine 2025. link 27 Ren Q, Lv X, Li J, Xu Q. Predictive value of 72-hour serum potassium variability, age, and total bilirubin for the prognosis of septic patients with heart failure: A retrospective cohort study based on the MIMIC-IV database. Medicine 2025. link 28 Fernando SM, Tran A, Soliman K, Flynn B, Oommen T, Wenzhe L et al.. Methylene Blue in Septic Shock: A Systematic Review and Meta-Analysis. Critical care explorations 2024. link 29 Sankar J, Das RR, Banothu KK. Fluid resuscitation in children with severe infection and septic shock: a systematic review and meta-analysis. European journal of pediatrics 2024. link 30 Marchetto L, Zanetto L, Comoretto RI, Padrin D, Menon K, Amigoni A et al.. OUTCOMES OF PEDIATRIC FLUID-REFRACTORY SEPTIC SHOCK ACCORDING TO DIFFERENT VASOACTIVE STRATEGIES: A SYSTEMATIC REVIEW AND META-ANALYSIS. Shock (Augusta, Ga.) 2024. link 31 Ahn C, Yu G, Shin TG, Cho Y, Park S, Suh GY. Comparison of Early and Late Norepinephrine Administration in Patients With Septic Shock: A Systematic Review and Meta-Analysis. Chest 2024. link 32 Lin SP, Xu XJ, Liao C, Zhao N, Chen YY, Song H et al.. The predictive utility of cytokines, procalcitonin and C-reactive protein among febrile pediatric hematology and oncology patients with severe sepsis or septic shock. Pediatric hematology and oncology 2024. link 33 Lehner GF, Tobiasch AK, Perschinka F, Mayerhöfer T, Waditzer M, Haller V et al.. Associations of tissue factor and tissue factor pathway inhibitor with organ dysfunctions in septic shock. Scientific reports 2024. link 34 Bestle MH, Stensballe J, Lange T, Clausen NE, Søe-Jensen P, Pedersen KH et al.. Iloprost and Organ Dysfunction in Adults With Septic Shock and Endotheliopathy: A Randomized Clinical Trial. JAMA network open 2024. link 35 Schlapbach LJ, Raman S, Buckley D, George S, King M, Ridolfi R et al.. Resuscitation With Vitamin C, Hydrocortisone, and Thiamin in Children With Septic Shock: A Multicenter Randomized Pilot Study. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 2024. link 36 Atreya MR, Piraino G, Cvijanovich NZ, Fitzgerald JC, Weiss SL, Bigham MT et al.. SERUM HUMANIN IN PEDIATRIC SEPTIC SHOCK-ASSOCIATED MULTIPLE-ORGAN DYSFUNCTION SYNDROME. Shock (Augusta, Ga.) 2024. link 37 Harley A, George S, Phillips N, King M, Long D, Keijzers G et al.. Resuscitation With Early Adrenaline Infusion for Children With Septic Shock: A Randomized Pilot Trial. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 2024. link 38 Huang D, You C, Mai X, Li L, Meng Q, Liang Z. Lung ultrasound-guided fluid resuscitation in neonatal septic shock: A randomized controlled trial. European journal of pediatrics 2024. link 39 Tang F, Liu D, Wan F, Zhang L, Xu LY, Zhang JN et al.. Ameliorative effect of anisodamine (654-1/654-2) against myocardial dysfunction induced by septic shock via the NF-κB/NLRP-3 or the PI3K-AKT/NF-κB pathway. Phytomedicine : international journal of phytotherapy and phytopharmacology 2024. link 40 Warnock B, Lafferty GM, Farhat A, Colgate C, Dhar A, Gray B. Peripheral Veno-Arterial-Extracorporeal Membrane Oxygenation for Refractory Septic Shock in Children: A Multicenter Review. Journal of intensive care medicine 2024. link 41 Jouffroy R, Gille S, Gilbert B, Travers S, Bloch-Laine E, Ecollan P et al.. RELATIONSHIP BETWEEN SHOCK INDEX, MODIFIED SHOCK INDEX, AND AGE SHOCK INDEX AND 28-DAY MORTALITY AMONG PATIENTS WITH PREHOSPITAL SEPTIC SHOCK. The Journal of emergency medicine 2024. link 42 Pruszczyk A, Zawadka M, Andruszkiewicz P, LaVia L, Herpain A, Sato R et al.. Mortality in patients with septic cardiomyopathy identified by longitudinal strain by speckle tracking echocardiography: An updated systematic review and meta-analysis with trial sequential analysis. Anaesthesia, critical care & pain medicine 2024. link 43 Beagle AJ, Prasad PA, Hubbard CC, Walderich S, Oreper S, Abe-Jones Y et al.. Associations Between Volume of Early Intravenous Fluid and Hospital Outcomes in Septic Patients With and Without Heart Failure: A Retrospective Cohort Study. Critical care explorations 2024. link 44 Ford VJ, Applefeld WN, Wang J, Sun J, Solomon SB, Sidenko S et al.. Cardiac Magnetic Resonance Studies in a Large Animal Model That Simulates the Cardiac Abnormalities of Human Septic Shock. Journal of the American Heart Association 2024. link 45 Liu Q, Zhao A, Wu X, Zhang X, Li X, Yang W et al.. Identifying and validating potential therapeutic targets for septic heart failure and the cardioprotective effects of lycorine. Phytomedicine : international journal of phytotherapy and phytopharmacology 2024. link 46 Jia L, Wang P, Li C, Xie J. THE EFFICACY AND SAFETY OF VASOPRESSORS FOR SEPTIC SHOCK PATIENTS: A SYSTEMIC REVIEW AND NETWORK META-ANALYSIS. Shock (Augusta, Ga.) 2023. link 47 Zomer PML, Kamps MJA. Septic shock due to Clostridium botulinum: a case report. Journal of medical case reports 2023. link 48 Bauer SR, Sacha GL, Siuba MT, Wang L, Wang X, Scheraga RG et al.. Vasopressin Response and Clinical Trajectory in Septic Shock Patients. Journal of intensive care medicine 2023. link 49 Cutuli SL, De Rosa S, Ferrer R, Ruiz-Rodriguez JC, Forfori F, Ronco C et al.. Endotoxin activity trend and multi-organ dysfunction in critically ill patients with septic shock, who received Polymyxin-B hemadsorption: A multicenter, prospective, observational study. Artificial organs 2023. link 50 Aisa-Álvarez A, Pérez-Torres I, Guarner-Lans V, Manzano-Pech L, Cruz-Soto R, Márquez-Velasco R et al.. Randomized Clinical Trial of Antioxidant Therapy Patients with Septic Shock and Organ Dysfunction in the ICU: SOFA Score Reduction by Improvement of the Enzymatic and Non-Enzymatic Antioxidant System. Cells 2023. link 51 Centner FS, Schoettler JJ, Brohm K, Mindt S, Jäger E, Hahn B et al.. S-Adenosylhomocysteine Is a Useful Metabolic Factor in the Early Prediction of Septic Disease Progression and Death in Critically Ill Patients: A Prospective Cohort Study. International journal of molecular sciences 2023. link 52 Jiang Z, Luo F, Liu Y, Sun X, Tan G, Chen Z et al.. RESTRICTIVE FLUID RESUSCITATION IN SEPTIC SHOCK PATIENTS HAS LOWER MORTALITY AND ORGAN DYSFUNCTION RATES THAN STANDARD THERAPY. Shock (Augusta, Ga.) 2023. link 53 Atreya MR, Cvijanovich NZ, Fitzgerald JC, Weiss SL, Bigham MT, Jain PN et al.. SERUM SOLUBLE ENDOGLIN IN PEDIATRIC SEPTIC SHOCK-ASSOCIATED MULTIPLE ORGAN DYSFUNCTION SYNDROME. Shock (Augusta, Ga.) 2023. link 54 David S, Bode C, Stahl K. EXCHANGE-2: investigating the efficacy of add-on plasma exchange as an adjunctive strategy against septic shock-a study protocol for a randomized, prospective, multicenter, open-label, controlled, parallel-group trial. Trials 2023. link 55 Blakeslee PA, Hyrkäs K. Impact of supplemental thiamin on lactate levels in adults with septic shock. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition 2023. link 56 Vindhyal MR, Vasudeva R, Pothuru S, James Kallail K, Choi W, Ablah E et al.. In-hospital Outcomes of Patients with Septic Shock and Underlying Chronic Atrial Fibrillation: A Propensity Matched Analysis from A National Dataset. Journal of intensive care medicine 2023. link 57 Cao M, Shi M, Zhou B, Jiang H. An overview of the mechanisms and potential roles of extracellular vesicles in septic shock. Frontiers in immunology 2023. link 58 Bergman ZR, Kiberenge RK, Mohammed A, Bianco RW, Beilman GJ, Brophy CM et al.. Central Venous Waveform Analysis and Cardiac Output in a Porcine Model of Endotoxemic Hypotension and Resuscitation. Journal of the American College of Surgeons 2023. link 59 Patel JJ, Willoughby R, Peterson J, Carver T, Zelten J, Markiewicz A et al.. High-Dose IV Hydroxocobalamin (Vitamin B12) in Septic Shock: A Double-Blind, Allocation-Concealed, Placebo-Controlled Single-Center Pilot Randomized Controlled Trial (The Intravenous Hydroxocobalamin in Septic Shock Trial). Chest 2023. link 60 Teja B, Bosch NA, Walkey AJ. How We Escalate Vasopressor and Corticosteroid Therapy in Patients With Septic Shock. Chest 2023. link 61 Helwani MA, Lim A. Is venoarterial extracorporeal membrane oxygenation an option for managing septic shock. Current opinion in anaesthesiology 2023. link 62 Pacheco LD, Shepherd MC, Saade GS. Septic Shock and Cardiac Arrest in Obstetrics: A Practical Simplified Clinical View. Obstetrics and gynecology clinics of North America 2022. link 63 Rosenberg K. Outcomes Similar with Restricted vs. Standard IV Fluid Administration in Patients with Septic Shock. The American journal of nursing 2022. link 64 Ruiz-Rodríguez JC, Chiscano-Camón L, Palmada C, Ruiz-Sanmartin A, Pérez-Carrasco M, Larrosa N et al.. Endotoxin and Cytokine Sequential Hemoadsorption in Septic Shock and Multi-Organ Failure. Blood purification 2022. link 65 Thomas K, Strong L, Fan F, Roman RJ. Turn Up the HETE on Septic Shock. Journal of cardiovascular pharmacology 2022. link 66 Yang X, Zhou Y, Liu A, Pu Z. Relationship between Dynamic Changes of Microcirculation Flow, Tissue Perfusion Parameters, and Lactate Level and Mortality of Septic Shock in ICU. Contrast media & molecular imaging 2022. link 67 Rydz AC, Elefritz JL, Conroy M, Disney KA, Miller CJ, Porter K et al.. EARLY INITIATION OF VASOPRESSIN REDUCES ORGAN FAILURE AND MORTALITY IN SEPTIC SHOCK. Shock (Augusta, Ga.) 2022. link 68 Cour M, Klouche K, Souweine B, Quenot JP, Schwebel C, Perinel S et al.. Remote ischemic conditioning in septic shock: the RECO-Sepsis randomized clinical trial. Intensive care medicine 2022. link 69 Atreya MR, Cvijanovich NZ, Fitzgerald JC, Weiss SL, Bigham MT, Jain PN et al.. Integrated PERSEVERE and endothelial biomarker risk model predicts death and persistent MODS in pediatric septic shock: a secondary analysis of a prospective observational study. Critical care (London, England) 2022. link 70 Pölkki A, Pekkarinen PT, Takala J, Selander T, Reinikainen M. Association of Sequential Organ Failure Assessment (SOFA) components with mortality. Acta anaesthesiologica Scandinavica 2022. link 71 Rosengrave P, Spencer E, Williman J, Mehrtens J, Morgan S, Doyle T et al.. Intravenous vitamin C administration to patients with septic shock: a pilot randomised controlled trial. Critical care (London, England) 2022. link 72 Cai B, Lv X, Lin M, Feng C, Chen C. Clinical efficacy and safety of vitamin C in the treatment of septic shock patients: systematic review and meta-analysis. Annals of palliative medicine 2022. link 73 Porizka M, Rulisek J, Flaksa M, Otahal M, Lips M, Belohlavek J et al.. Dual veno-arterial extra-corporeal membrane oxygenation support in a patient with refractory hyperdynamic septic shock: a case report. Perfusion 2022. link 74 Taylor A, Jones T, Forehand CC, Smith SE, Dykes H, Newsome AS. Vasopressor Discontinuation Order in Septic Shock With Reduced Left Ventricular Function. Journal of pharmacy practice 2022. link 75 Vanbiervliet V, Demeyer I, Claus F, Van Vaerenbergh K. A case report: septic shock due to (tropical) pyomyositis and multiple metastatic embolisms caused by Panton Valentine Leukocidin-positive methicillin-sensitive staphylococcus aureus in a 12-year-old boy. Acta clinica Belgica 2022. link 76 Costa-Pinto R, Yong ZT, Yanase F, Young C, Brown A, Udy A et al.. A pilot, feasibility, randomised controlled trial of midodrine as adjunctive vasopressor for low-dose vasopressor-dependent hypotension in intensive care patients: The MAVERIC study. Journal of critical care 2022. link 77 Yu G, Cheng K, Liu Q, Lin X, Lin F, Wu W. Association between left ventricular diastolic dysfunction and septic acute kidney injury in severe sepsis and septic shock: A multicenter retrospective study. Perfusion 2022. link 78 Ehrman RR, Ottenhoff JD, Favot MJ, Harrison NE, Khait L, Welch RD et al.. Do septic patients with reduced left ventricular ejection fraction require a low-volume resuscitative strategy?. The American journal of emergency medicine 2022. link 79 Ruth A, Vogel AM, Adachi I, Shekerdemian LS, Bastero P, Thomas JA. Central venoarterial extracorporeal life support in pediatric refractory septic shock: a single center experience. Perfusion 2022. link 80 Vasudeva R, Challa A, Tuck N, Pothuru S, Vindhyal M. Hospital outcomes for patients with pulmonary arterial hypertension in sepsis and septic shock. BMC pulmonary medicine 2022. link 81 Tang N, Tian W, Ma GY, Xiao X, Zhou L, Li ZZ et al.. TRPC channels blockade abolishes endotoxemic cardiac dysfunction by hampering intracellular inflammation and Ca. Nature communications 2022. link 82 Yue S, Li S, Huang X, Liu J, Hou X, Wang Y et al.. Construction and Validation of a Risk Prediction Model for Acute Kidney Injury in Patients Suffering from Septic Shock. Disease markers 2022. link 83 Ruslan MA, Baharuddin KA, Noor NM, Yazid MB, Noh AYM, Rahman A. Norepinephrine in Septic Shock: A Systematic Review and Meta-analysis. The western journal of emergency medicine 2021. link 84 Scholz SS, Borgstedt R, Ebeling N, Menzel LC, Jansen G, Rehberg S. Mortality in septic patients treated with vitamin C: a systematic meta-analysis. Critical care (London, England) 2021. link 85 Urman RD, August DA, Chung S, Jiddou AH, Buckley C, Fields KG et al.. The effect of emergency manuals on team performance during two different simulated perioperative crises: A prospective, randomized controlled trial. Journal of clinical anesthesia 2021. link 86 Huang W, Wang X, Zhang H, Wang G, Xie F, Liu D. Serum Mitochondrial Quality Control Related Biomarker Levels are Associated with Organ Dysfunction in Septic Patients. Shock (Augusta, Ga.) 2021. link 87 Viderman D, Umbetzhanov Y, Temirov T, Kuzkov VV. Refractory gram-negative septic shock complicated by extended purpura fulminans and multiple organ failure in a 23-year-old puerpera -a case report. Korean journal of anesthesiology 2021. link 88 Agarwal A, Hager DN, Sevransky JE. Any Role of High-Dose Vitamin C for Septic Shock in 2021?. Seminars in respiratory and critical care medicine 2021. link 89 Ravikumar N, Sayed MA, Poonsuph CJ, Sehgal R, Shirke MM, Harky A. Septic Cardiomyopathy: From Basics to Management Choices. Current problems in cardiology 2021. link 90 Innocenti F, Palmieri V, Stefanone VT, D'Argenzio F, Cigana M, Montuori M et al.. Prognostic stratification in septic patients with overt and cryptic shock by speckle tracking echocardiography. Internal and emergency medicine 2021. link 91 Bazalgette F, Roger C, Louart B, Daurat A, Bobbia X, Lefrant JY et al.. Prognostic value and time course evolution left ventricular global longitudinal strain in septic shock: an exploratory prospective study. Journal of clinical monitoring and computing 2021. link 92 Chenouard A, Toulgoat F, Rolland A, Liet JM, Maminirina P, Joram N et al.. Right watershed cerebral infarction following neck cannulation for veno-arterial extracorporeal membrane oxygenation in pediatric septic shock: a case series. Perfusion 2021. link 93 Sanfilippo F, Huang S, Messina A, Franchi F, Oliveri F, Vieillard-Baron A et al.. Systolic dysfunction as evaluated by tissue Doppler imaging echocardiography and mortality in septic patients: A systematic review and meta-analysis. Journal of critical care 2021. link 94 Weiss SL, Peters MJ, Alhazzani W, Agus MSD, Flori HR, Inwald DP et al.. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 2020. link 95 Cioccari L, Luethi N, Bailey M, Shehabi Y, Howe B, Messmer AS et al.. The effect of dexmedetomidine on vasopressor requirements in patients with septic shock: a subgroup analysis of the Sedation Practice in Intensive Care Evaluation [SPICE III] Trial. Critical care (London, England) 2020. link 96 De Zylva J, Padley J, Badbess R, Dedigama M. Multiorgan failure following gastroenteritis: a case report. Journal of medical case reports 2020. link 97 Moskowitz A, Huang DT, Hou PC, Gong J, Doshi PB, Grossestreuer AV et al.. Effect of Ascorbic Acid, Corticosteroids, and Thiamine on Organ Injury in Septic Shock: The ACTS Randomized Clinical Trial. JAMA 2020. link 98 Bestle MH, Clausen NE, Søe-Jensen P, Kristiansen KT, Lange T, Johansson PI et al.. Efficacy and safety of iloprost in patients with septic shock-induced endotheliopathy-Protocol for the multicenter randomized, placebo-controlled, blinded, investigator-initiated trial. Acta anaesthesiologica Scandinavica 2020. link 99 Wardi G, Joel I, Villar J, Lava M, Gross E, Tolia V et al.. Equipoise in Appropriate Initial Volume Resuscitation for Patients in Septic Shock With Heart Failure: Results of a Multicenter Clinician Survey. Journal of intensive care medicine 2020. link 100 Colon Hidalgo D, Patel J, Masic D, Park D, Rech MA. Delayed vasopressor initiation is associated with increased mortality in patients with septic shock. Journal of critical care 2020. link

    Original source

    1. [1]
      Effect of norepinephrine versus vasopressin weaning on incidence of hypotension in septic shock patients: a systematic review and meta-analysis.Mallmann C, Silva LOJ, Oliveira MS, Galiotto TMB, Nedel WL, Moraes RB Critical care science (2026)
    2. [2]
    3. [3]
      Hyperdynamic left ventricular ejection fraction as a predictor of mortality in intensive care unit patients with septic shock.Hedia DSM, Mahmoud HO, AbdelFattah AM, AbdelSalam EH, Mahmoud OS Heart & lung : the journal of critical care (2026)
    4. [4]
      Time to Vasopressor Initiation Is Not Associated With Increased Mortality in Patients With Septic Shock.Black LP, Hopson C, Puskarich MA, Modave F, McCarthy DM, DeVos E et al. Annals of emergency medicine (2026)
    5. [5]
    6. [6]
      Time-Dependent Fluid Accumulation Index for Phase-Specific Risk Stratification in Septic Shock with Heart Failure.Liu QF, Ge L, Yao D, Huang XM, Li GC, Gong NJ Current medical science (2026)
    7. [7]
      Low-Dose Hydrocortisone in Cirrhotic Patients With Septic Shock: A Double-Blind Randomised Placebo-Controlled Trial.Meersseman P, Hernández-Tejero M, Diaz JM, Wauters J, Hermans G, Aziz F et al. Liver international : official journal of the International Association for the Study of the Liver (2025)
    8. [8]
      Balanced crystalloid versus saline for resuscitation in pediatric septic shock: a systematic review and meta-analysis.Vijendra B, Bertol AB, de Almeida MMG, de Freitas PHAG, Simão ÁMS, de Faria BL BMC pediatrics (2025)
    9. [9]
      Dynamic Measures of Fluid Responsiveness to Guide Resuscitation in Patients With Sepsis and Septic Shock: A Systematic Review and Meta-Analysis.Wang J, Blake LM, Orozco N, Fiorini K, McChesney C, Slessarev M et al. Critical care explorations (2025)
    10. [10]
      The effects of vasopressor choice on renal outcomes in septic shock: a systematic review of randomised trials as a guide for future research.McDonald R, Burns M, Wong A, Smith C, Ostermann M, Hutchings S Critical care (London, England) (2025)
    11. [11]
      The use of methylene blue in adult patients with septic shock: a systematic review and meta-analysis.Ng KT, Kwok PE, Lim WE, Teoh WY, Hasan MS, Zainal Abidin MF Brazilian journal of anesthesiology (Elsevier) (2025)
    12. [12]
      ADJUNCTIVE VASOPRESSORS AND SHORT-TERM MORTALITY IN ADULTS WITH SEPTIC SHOCK: A SYSTEMATIC REVIEW AND META-ANALYSIS.Bauer SR, Wieruszewski PM, Bissell Turpin BD, Dugar S, Sacha GL, Sato R et al. Shock (Augusta, Ga.) (2025)
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      Application of norepinephrine in the treatment of septic shock: a meta-analysis.Xu QY, Jin YH, Fu L, Li YY Irish journal of medical science (2025)
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      Effect of therapeutic plasma exchange on amoxicillin, clindamycin, midazolam, and morphine pharmacokinetics in a critically ill child.Yaghyazaryan A, Gracchi V, Zielhuis SWJ, Schölvinck EH, Touw DJ, Kneyber MCJ et al. Pediatric nephrology (Berlin, Germany) (2025)
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      Endotoxin hemoadsorption in refractory septic shock with multiorgan dysfunction and extreme endotoxin activity.Ruiz-Rodríguez JC, Chiscano-Camón L, Bajaña I, Ruiz-Sanmartin A, Bastidas J, Maldonado C et al. Critical care (London, England) (2025)
    17. [17]
      Management dilemma in choosing evolving treatments in neutropenic septic shock.Humes HD, Luckritz K, Gorga S, Plomaritas K, Hoatlin S, Humes M et al. Pediatric nephrology (Berlin, Germany) (2025)
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      Acute infectious purpura fulminant due to Enterococcus faecium infection: a case report.Tanbour RG, Amer R, Matar AN, Aiesh BM Journal of medical case reports (2025)
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