TY  - JOUR
AU  - João Rêgo Araújo
AU  - Amália Cinthia Meneses Rêgo
AU  - Irami Araújo-Filho
PY  - 2026
DA  - 2026/09/03
TI  - Persistent Shock After Source Control in Intra- Abdominal Sepsis: A Structured Critical Review and a Time-Triggered Reassessment Algorithm
JO  - Surgery Research Journal
VL  - 6
IS  - 2
AB  - Intra-abdominal sepsis is a frequent and lethal cause of septic shock in critically ill adults, and early,
adequate source control is a cornerstone of management. Yet after operative or percutaneous source
control, many patients remain in shock in the intensive care unit, occupying a clinical gray zone: residual
or recurrent shock may reflect expected postoperative inflammation, vasoplegia, hypovolemia and
reperfusion, or it may signal undrained or progressive anatomical disease or microbiological failure.
In this structured critical narrative review, reported following SANRA and not a systematic review, we
propose that persistent shock after abdominal source control be interpreted as a time-dependent Bayesian
signal. We provide operational definitions, distinguish the postoperative inflammatory–hemodynamic
trajectory from ongoing disease, and map hemodynamic, metabolic, organ-dysfunction, abdominal,
bedside, radiological, microbiological, surgical-context and cognitive triggers, organized into three
phases—0–24 h (vigilant tolerance), 24–48 h (inflection point) and 48–72 h (presumed failure zone).
Persistent shock is not, by itself, diagnostic of source-control failure, but it should raise the pre-test
probability of ongoing anatomical or microbiological disease and trigger structured, interdisciplinary
reassessment—re-imaging, antimicrobial review, drainage or reintervention, and formal exclusion of
extra-abdominal causes—within 24–72 hours. The 48–72 h window is a safety threshold for mandatory
reassessment, not a diagnostic threshold for failure. This hypothesis-generating algorithm is not
a validated guideline and does not replace clinical judgment; it may reduce diagnostic inertia, and
prospective, multicenter validation is required.
SN  - 2768-0428
UR  - https://dx.doi.org/10.33425/2768-0428.1055
DO  - 10.33425/2768-0428.1055