Discussion about palliative care with the family and the provider will be the best intervention.
Even if the refractory shock's underlying cause is treated and mean arterial pressure momentarily returns to normal, treatment cannot save the client's life during this irreversible period. Palliative care should be covered in the conversation. Recovery or going home again are improbable. Organ transplantation is not an option for the patient who has persistent tissue hypoxia.
Poor tissue perfusion, hypotension, and organ failure define refractory shock, a potentially lethal sign of circulatory failure with limited responsiveness to vasopressors.
The presence of hypotension and end-organ failure, as well as the need for high-dose vasopressor support—often higher than 0.5 g/kg/min norepinephrine or equivalent—are variously characterized as signs of refractory shock. Regardless of the specific criteria, a mortality rate of up to 60% is related.
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