Septic shock: a label the treatment creates

Review and sources

Not clinically reviewed. No clinician has signed this scenario.

• Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-810. doi:10.1001/jama.2016.0287. Box 3: septic shock is identified by a clinical construct of sepsis with persisting hypotension requiring vasopressors to maintain MAP >= 65 mmHg and a serum lactate > 2 mmol/L despite adequate volume resuscitation. The task force states that criteria for adequate fluid resuscitation and for need for vasopressor therapy could not be explicitly specified because these are highly user dependent.
• Prescott HC, Antonelli M, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026. Crit Care Med. Published 2026-03-23. doi:10.1097/CCM.0000000000007075. Initial MAP target 65 mmHg over higher targets, strong recommendation, moderate certainty; for adults 65 or older an initial range of 60 to 65 mmHg, conditional, low certainty; at least 30 mL/kg crystalloid in the first 3 hours, conditional, low certainty; initial crystalloid followed by vasopressor support if hypotension persists, conditional, very low certainty, with a carve-out for concurrent vasopressors in unstable shock; serial lactate to guide resuscitation, conditional, low certainty, individualized after the initial bolus by lactate decrement rather than continuing fluids until normalization. Statement numbers were not retrievable; wording taken from the issuing society guideline page.
• Levy B. Lactate and shock state: the metabolic view. Curr Opin Crit Care. 2006. PMID 18323749. Hyperlactatemia in sepsis is substantially driven by epinephrine-stimulated aerobic glycolysis in skeletal muscle and by reduced hepatic clearance, so an elevated lactate is not a direct reading of tissue oxygen debt.