Septic shock remains a health care concern associated with significant morbidity and mortality. The Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock recommend early fluid resuscitation and antimicrobials. Beyond initial management, the guidelines do not provide clear recommendations on appropriate time to initiate vasoactive therapies and corticosteroids in patients who develop shock. This review summarizes the literature regarding time of initiation of these interventions. Clinical data regarding time of initiation of these therapies in relation to shock onset, sequence of treatments with regard to each other, and clinical markers evaluated to guide initiation are summarized. Early-high vasopressor initiation within first 6 h of shock onset is associated with lower mortality. Following norepinephrine initiation, the exact dose and timing of escalation to adjunctive vasopressor agents are not well elucidated in the literature. However, recent data indicate that timing may be an important factor in initiating vasopressors and adjunctive therapies, such as corticosteroids. Norepinephrine-equivalent dose and lactate concentration can aid in determining when to initiate vasopressin and angiotensin II in patients with septic shock. Future guidelines with clear recommendations on the time of initiation of septic shock therapies are warranted.

感染性休克仍然是与显着发病率和死亡率相关的医疗保健问题。脓毒症和脓毒性休克的生存脓毒症运动指南推荐早期液体复苏和抗菌药物。除了初始管理外，该指南没有就发生休克的患者开始血管活性治疗和皮质类固醇的适当时间提供明确的建议。本综述总结了有关这些干预措施开始时间的文献。总结了与休克发作相关的这些治疗开始时间、治疗顺序以及指导开始评估的临床标志物的临床数据。在休克发作的前 6 小时内使用早期高血管加压药与较低的死亡率相关。去甲肾上腺素启动后，文献中没有很好地阐明增加血管加压药物的确切剂量和时间。然而，最近的数据表明，时机可能是启动血管加压药和辅助治疗（如皮质类固醇）的重要因素。去甲肾上腺素当量剂量和乳酸浓度有助于确定感染性休克患者何时开始使用加压素和血管紧张素 II。未来的指南对开始感染性休克治疗的时间提出明确建议是必要的。去甲肾上腺素当量剂量和乳酸浓度有助于确定感染性休克患者何时开始使用加压素和血管紧张素 II。未来的指南对开始感染性休克治疗的时间提出明确建议是必要的。去甲肾上腺素当量剂量和乳酸浓度有助于确定感染性休克患者何时开始使用加压素和血管紧张素 II。未来的指南对开始感染性休克治疗的时间提出明确建议是必要的。