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Septic shock — ABIM Board MCQ

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HardPulmonary/Critical CareSeptic shockABIM Board

A patient with septic shock is receiving norepinephrine at an increasing dose after appropriate fluid resuscitation, antibiotics and source-control planning. Mean arterial pressure remains 58 mm Hg. Which vasoactive adjustment is preferred?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Add vasopressin rather than escalating norepinephrine indefinitely

The best answer is “Add vasopressin rather than escalating norepinephrine indefinitely”. Vasopressin is commonly added when norepinephrine requirements are rising, improving pressure through a complementary pathway and limiting catecholamine exposure. Dopamine is more arrhythmogenic, bicarbonate does not replace vasopressor support, fixed filling-pressure targets should not delay treatment, and corticosteroids—when used—supplement rather than substitute for vasopressors.

Reference: Surviving Sepsis Campaign 2026 Adult Guideline: https://www.sccm.org/survivingsepsiscampaign/guidelines-and-resources/surviving-sepsis-campaign-adult-guidelines