DOI: 10.1177/30502225261502353 ISSN: 3050-2225

Beyond a Fixed Fluid Threshold in Refractory Pediatric Septic Shock: A Proposed Response-Tolerance-Trajectory Framework

Weerapong Lilitwat
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This Letter clarifies that the 40–60 mL/kg recommendation for initial pediatric septic shock resuscitation is not a prerequisite for recognizing refractory shock. We propose an unvalidated response–tolerance–trajectory documentation sequence applied after each intervention, with explicit findings and a next-action trigger. It is intended to complement existing phenotype-guided practice and severity definitions, not establish a new diagnostic score. Prospective evaluation is needed.

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