Evidence map›Paper›PMID 41514386›Full record

ReviewJournal of anesthesia, analgesia and critical care2026

Refractory septic shock: our updated pragmatic approach.

Filippo Palmesino, Adam Woodman-Bailey, Fraser Hanks, Stephanie Khoo, Marlies Ostermann, Nicholas Ioannou, Christopher Meadows, Duncan Wyncoll

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Journal of anesthesia, analgesia and critical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Filippo PalmesinoDepartment of Critical Care, Guy's and St Thomas' NHS Trust, London, SE1 7EH, UK.
Adam Woodman-BaileyDepartment of Critical Care, Guy's and St Thomas' NHS Trust, London, SE1 7EH, UK.
Fraser HanksDepartment of Critical Care, Guy's and St Thomas' NHS Trust, London, SE1 7EH, UK.
Stephanie KhooDepartment of Critical Care, Guy's and St Thomas' NHS Trust, London, SE1 7EH, UK.
Marlies OstermannDepartment of Critical Care, Guy's and St Thomas' NHS Trust, London, SE1 7EH, UK.
Nicholas IoannouDepartment of Critical Care, Guy's and St Thomas' NHS Trust, London, SE1 7EH, UK.
Christopher MeadowsDepartment of Critical Care, Guy's and St Thomas' NHS Trust, London, SE1 7EH, UK.
Duncan WyncollDepartment of Critical Care, Guy's and St Thomas' NHS Trust, London, SE1 7EH, UK. d.wyncoll@nhs.net.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Despite the refinement in guidelines and improving outcomes, a subset of patients with septic shock fails to respond to treatment and progresses into refractory septic shock with an associated high morbidity and mortality. This population remains underrepresented in clinical trials due to their heterogeneity, in addition to time and ethical constraints. As a large specialist referral centre, we propose an updated, pragmatic, and largely inexpensive approach based on our current clinical practice, which focuses on early multimodal therapy, aiming to reduce the detrimental effects associated with high-dose vasopressors.

Indexed as

Catecholamine toxicityMulti-organ failureRefractory septic shockSeptic cardiomyopathyToxic shockVasoplegic shock

Identifiers

PMID41514386
PMCPMC12882134

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.