Current standard of care for septic shock

Anthony Delaney^{1

2

3

4}, Marcio Borges-Sa^{5

6

7

8}, Michelle S Chew^{9

10}, Jan J De Waele^{11

12}, Jacob Dye^{13

14}, Ashish K Khanna^{15

16

17}, Olfa Hamzaoui^{18

19}, Naomi Hammond^{13

20}, Glenn Hernandez²¹, Margaret Herridge²², Jeffrey Lipman^{23

24

25}, Flavia R Machado²⁶, Armand Mekontso Dessap^{27

28}, Xavier Monnet²⁹, Sheila N Myatra³⁰, Balasubramanian Venkatesh^{13

31}, Daniel De Backer³²

Affiliations

¹ Critical Care Program, The George Institute for Global Health, UNSW, Sydney, Australia. adelaney@georgeinstitute.org.au.
² Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, St Leonards, Australia. adelaney@georgeinstitute.org.au.
³ Northern Clinical School, Sydney Medical School, St. Leonards, Australia. adelaney@georgeinstitute.org.au.
⁴ ANZIC Research Centre, Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia. adelaney@georgeinstitute.org.au.
⁵ Multidisciplinary Sepsis Unit, ICU, Son Llatzer University Hospital, Palma Mallorca, Spain.
⁶ Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain.
⁷ School of Medicine of Balearic Islands University, Palma Mallorca, Spain.
⁸ Fundación Código Sepsis, Valencia, Spain.
⁹ Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Huddinge, Sweden.
¹⁰ Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
¹¹ Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
¹² Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
¹³ Critical Care Program, The George Institute for Global Health, UNSW, Sydney, Australia.
¹⁴ Collaborative Evaluation and Research Centre, Federation University, Churchill, Australia.
¹⁵ Department of Anesthesiology, Division of Critical Care Medicine, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, USA.
¹⁶ Perioperative Outcomes and Informatics Collaborative, Winston-Salem, USA.
¹⁷ Outcomes Research Consortium, Houston, USA.
¹⁸ Unité de Médecine Intensive Et Réanimation Polyvalente, CHU Reims, Reims, France.
¹⁹ Université de Reims Champagne-Ardenne, Unité PPF "Pharmacologie et Pathologies Fragilisantes" UR 3801, Reims, France.
²⁰ Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, St Leonards, Australia.
²¹ Departamento de Medicina Intensiva, Facultad de Medicina, Pontifica Universidad Catolica de Chile, Santiago, Chile.
²² Critical Care and Respiratory Medicine, Institute of Medical Sciences, Interdepartmental Division of Critical Care Medicine, University Health Network, Toronto General Research Institute, University of Toronto, Toronto, Canada.
²³ The University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia.
²⁴ R UM 103, University of Montpellier, Division of Anesthesia Critical Care and Emergency and Pain Medicine, Nimes University Hospital, Nimes, France.
²⁵ Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Queensland University of Technology (QUT), Brisbance, Australia.
²⁶ Intensive Care Department, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
²⁷ Medical Intensive Care, Henri-Mondor Hospital, AP-HP, Creteil, France.
²⁸ CARMAS Research Group, IMRB, INSERM, UPEC, Créteil, France.
²⁹ AP-HP, Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, DMU 4 CORREVE, IHU SEPSIS, CARMAS, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
³⁰ Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
³¹ Gold Coast University Hospital, Southport, QLD, Australia.
³² Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium.

PMID: 41359028
DOI: 10.1007/s00134-025-08211-6

Review

Current standard of care for septic shock

Anthony Delaney et al. Intensive Care Med. 2025.

. 2025 Dec 8.

doi: 10.1007/s00134-025-08211-6. Online ahead of print.

Authors

Affiliations

¹ Critical Care Program, The George Institute for Global Health, UNSW, Sydney, Australia. adelaney@georgeinstitute.org.au.
² Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, St Leonards, Australia. adelaney@georgeinstitute.org.au.
³ Northern Clinical School, Sydney Medical School, St. Leonards, Australia. adelaney@georgeinstitute.org.au.
⁴ ANZIC Research Centre, Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia. adelaney@georgeinstitute.org.au.
⁵ Multidisciplinary Sepsis Unit, ICU, Son Llatzer University Hospital, Palma Mallorca, Spain.
⁶ Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain.
⁷ School of Medicine of Balearic Islands University, Palma Mallorca, Spain.
⁸ Fundación Código Sepsis, Valencia, Spain.
⁹ Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Huddinge, Sweden.
¹⁰ Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
¹¹ Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
¹² Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
¹³ Critical Care Program, The George Institute for Global Health, UNSW, Sydney, Australia.
¹⁴ Collaborative Evaluation and Research Centre, Federation University, Churchill, Australia.
¹⁵ Department of Anesthesiology, Division of Critical Care Medicine, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, USA.
¹⁶ Perioperative Outcomes and Informatics Collaborative, Winston-Salem, USA.
¹⁷ Outcomes Research Consortium, Houston, USA.
¹⁸ Unité de Médecine Intensive Et Réanimation Polyvalente, CHU Reims, Reims, France.
¹⁹ Université de Reims Champagne-Ardenne, Unité PPF "Pharmacologie et Pathologies Fragilisantes" UR 3801, Reims, France.
²⁰ Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, St Leonards, Australia.
²¹ Departamento de Medicina Intensiva, Facultad de Medicina, Pontifica Universidad Catolica de Chile, Santiago, Chile.
²² Critical Care and Respiratory Medicine, Institute of Medical Sciences, Interdepartmental Division of Critical Care Medicine, University Health Network, Toronto General Research Institute, University of Toronto, Toronto, Canada.
²³ The University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia.
²⁴ R UM 103, University of Montpellier, Division of Anesthesia Critical Care and Emergency and Pain Medicine, Nimes University Hospital, Nimes, France.
²⁵ Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Queensland University of Technology (QUT), Brisbance, Australia.
²⁶ Intensive Care Department, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
²⁷ Medical Intensive Care, Henri-Mondor Hospital, AP-HP, Creteil, France.
²⁸ CARMAS Research Group, IMRB, INSERM, UPEC, Créteil, France.
²⁹ AP-HP, Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, DMU 4 CORREVE, IHU SEPSIS, CARMAS, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
³⁰ Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
³¹ Gold Coast University Hospital, Southport, QLD, Australia.
³² Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium.

PMID: 41359028
DOI: 10.1007/s00134-025-08211-6

Erratum in

Author Correction: Current standard of care for septic shock.
Delaney A, Borges-Sa M, Chew MS, De Waele JJ, Dye J, Khanna AK, Hamzaoui O, Hammond N, Hernandez G, Herridge M, Lipman J, Machado FR, Mekontso Dessap A, Monnet X, Myatra SN, Venkatesh B, De Backer D. Delaney A, et al. Intensive Care Med. 2025 Dec 18. doi: 10.1007/s00134-025-08262-9. Online ahead of print. Intensive Care Med. 2025. PMID: 41410710 No abstract available.

Abstract

Sepsis is a syndrome of life-threatening organ dysfunction that results from dysregulated host response to infection, with septic shock defined as persistent hypotension despite fluid resuscitation, a serum lactate > 2 mmol/L and the need for a vasopressor infusion to maintain a mean arterial pressure of at least 65 mmHg. Approximately, 49 million cases of sepsis are recorded worldwide annually, with 11 million sepsis-related deaths, the majority occurring in patients with septic shock. A substantial proportion of survivors suffer from moderate to severe functional limitations including physical, cognitive and psychological disability, exacerbation of pre-existing chronic conditions and a high incidence of re-hospitalisation in the first 12 months after the initial diagnosis. Optimal management of patients with septic shock requires prompt and reliable recognition of patients with sepsis who require additional haemodynamic support. Initially, patients will need judicious intravenous fluids and consideration of the need for vasopressors such as norepinephrine. Administration of appropriate antibiotics and consideration for control of the source of infection are also required. In the optimisation phase, depending on patients' comorbidities and response to therapy, the balance of fluid therapy, vasopressors and potentially the addition of an inotropic agent will need to be adjusted, based on clinical findings and haemodynamic and biochemical parameters. For those patients who do not respond to initial therapy, more intensive monitoring may be required with consideration of adjunctive therapies such as corticosteroids, vasopressin, angiotensin II or other rescue therapies to achieve cardiovascular stability. Once stability has been achieved, clinicians need to consider strategies to ameliorate the potential long-term effects on survivors, while keeping in mind the perspective and experience of their patients.

Keywords: Antibiotics; Antimicrobials; Critical care; Intensive care medicine; Resuscitation; Sepsis; Septic shock.

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Conflict of interest statement

Declarations. Conflicts of interest: MSC is a Section Editor for Intensive Care Medicine. She has not taken part in the review or selection process of this article. AD: grants from the Australian National Health and Medical Research Council and Medical Research Future Fund paid to his Institution. MBS: MBS: Pfizer, AOP, Viatris, Biomerieux, Menarini. MSC: Edwards Lifesciences, Philips Healthcare, AOP, Laboratorie Agguetant, ESICM Chair Cardiodynamics section, ESICM Consensus on Shock and Haemodynamic Monitoring (co-chair), ESICM Consensus on Sepsis Induced Myocardial Dysfunction (co-chair). J.D.W. is supported by a Sr Clinical Research Grant from the Research Foundation Flanders (FWO, Ref. 1881020N) and consulted for Biomerieux, Menarini, MSD, Pfizer, Roche Diagnostics, ThermoFisher and Viatris (honoraria were paid to his institution). NH: Supported by a NHMRC Leadership Fellowship and Institutional Research Support from Baxter. MH is supported by a Tier 1 Canada Research Chair in Critical Illness Outcomes and the Recovery Continuum and receives funding support from the Canadian Institutes of Health. AKK: Medtronic, Edwards Lifesciences, Philips Research North America, Bayer Corporation, AOP, GE Healthcare, Innoviva Therapeutics, Viatris, SERB pharmaceuticals, Pharmazz Inc., Surviving Sepsis Campaign (Research Committee member), SCCM ESICM consensus definition of refractory septic shock (co-chair). Ongoing support Wake Forest CTSI: RAAS dysfunction in septic shock and NIH/NHLBI R01HL177834-01: Dysfunctional Renin Angiotensin System in Septic Shock. FRM: Member of The SSC 2026 guidelines, speaker’s fee from Baxter in 2025. AMD: Grants from Fischer Paykel and Terumo, and personal fees from Air Liquide, Terumo and Addmedica, all outside the submitted work. XM is a consultant for BD, Getinge and Pulsion Medical Systems. XM received honoraria for giving lectures from AOP health, Baxter healthcare, BD, Edwards Lifesciences, Getinge, Masimo and Philips healthcare. XM received an unrestricted research grant from Retia Medical, Masimo and Edwards Lifesciences. XM is an associate editor of Annals of Intensive Care, a member of the editorial board of Critical Care, and the editor-in-chief of Hemodynamics. SNM—Member of the Surviving Sepsis Campaign (SSC) 2026 Guidelines Committee and SSC Research Committee. Member of the Asia Pacific Sepsis Alliance (APSA). OH: AOP Healthcare and Viatris. DDB: Edwards Lifesciences, AOP Pharma, Pharmaz, Viatris. BV: Supported by a NHMRC Leadership Fellowship and Institutional Research Support from Baxter. JD, GH, JL declare no potential conflicts of interest.

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Current standard of care for septic shock

Affiliations

Current standard of care for septic shock

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Affiliations

Erratum in

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Conflict of interest statement

References

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