Septic shock: Past, present, and perspectives

Abstract

Septic shock remains one of the most severe complications of infection, defined by circulatory, cellular, and metabolic dysfunction and associated with persistently high mortality. The concept has evolved markedly, from early descriptions of "blood poisoning" to the recognition of sepsis as a systemic syndrome in the late 20th century. Consensus definitions and large clinical trials, including early goal-directed therapy, led to structured treatment bundles and the launch of the Surviving Sepsis Campaign, which have contributed to gradual improvements in survival. Current management emphasizes rapid recognition, timely antimicrobials, source control, fluid resuscitation, and vasopressor support, with norepinephrine as the first-line agent. Nevertheless, significant heterogeneity among patients complicates decision-making, and debate continues around fluid thresholds, timing of vasopressor initiation, and the use of adjunctive therapies such as corticosteroids or immunomodulators. Looking ahead, precision medicine and emerging technologies promise to refine sepsis care. Machine learning and multi-omic approaches are improving risk prediction, enabling identification of sepsis subphenotypes, and guiding individualized treatment strategies. Bedside tools assessing microcirculatory function and rapid biomarker assays may further enhance prognostication and resuscitation. Effective implementation science and rigorous validation of these tools will be critical for translating innovation into improved outcomes. Septic shock management has advanced substantially, yet further progress requires not only personalization and innovation but also concerted efforts to reduce global disparities in access to timely diagnosis, evidence-based treatment, and long-term survivorship care.

Keywords: Artificial intelligence; Critical care; Fluid therapy; Hemodynamic monitoring; Precision medicine; Sepsis; Septic shock; Vasopressor agents.