Table 4.

Summary of the expert’s recommendations and its degree of consensus and grade of recommendation

Statement	Degree of consensus	Grade of recommendation
Blood pressure monitoring
1. In patients with shock, arterial blood pressure should be monitored invasively and continuously via an arterial catheter	Perfect	Strong
Ideal moment to start vasopressor therapy in treating circulatory shock
2. Vasopressors should be started early, before (complete) completion of fluid resuscitation	Reasonable	Conditional
3. MAP or the combination of MAP and DAP should be considered as trigger to start vasopressor treatment	Good	Strong
Vasopressor of first choice
4. Norepinephrine should be used as vasopressor of first choice	Perfect	Strong
Target of vasopressor treatment
5. The target of vasopressor therapy should be a MAP of 65 mmHg	Good	Strong
6. Lower MAPs are tolerated in case of refractory hypotension despite adequate fluid and vasopressor treatment	Good	Strong
Treatment options in refractory hypotension
7. Adding a second vasopressor in case of refractory hypotension	Good	Strong
8. Using vasopressin or terlipressin as second vasopressor	Good	Strong
Reason to stop vasopressor treatment
9. Vasopressor treatment should be reduced/stopped when the patient improves clinically, when side effects occur, or in case of ineffectiveness	Perfect	Strong
Use of steroids to reach target
10. Steroids should be considered in septic shock	Good	Strong

Definitions of degree of consensus and grades of recommendations based on the RAND algorithm. All 34 experts in agreement defined a perfect consensus and experts ≥ 80% agreement defined good consensus; both were considered as strong recommendation. Reasonable consensus was defined as 70–80% agreement among experts, and the recommendation was considered to be conditional