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Over the past two decades, there have been considerable improvements in our understanding of the pathophysiology of sepsis and the host response, including regulation of inflammation, endothelial disruption and impaired immunity. This has offered opportunities for innovative adjunctive treatments such as vitamin C, corticosteroids and beta\u2010blockers. Some of these approaches have shown promising results in early phase trials in humans, while others, such as corticosteroids, have been tested in large, international, multicentre randomised controlled trials. Contemporary guidelines make a weak recommendation for the use of corticosteroids to reduce mortality in sepsis and septic shock. Vitamin C, despite showing initial promise in observational studies, has so far not been shown to be clinically effective in randomised trials. Beta\u2010blocker therapy may have beneficial cardiac and non\u2010cardiac effects in septic shock, but there is currently insufficient evidence to recommend their use for this condition. The results of ongoing randomised trials are awaited. Crucial to reducing heterogeneity in the trials of new sepsis treatments will be the concept of enrichment, which refers to the purposive selection of patients with clinical and biological characteristics that are likely to be responsive to the intervention being tested.<\/jats:p>","DOI":"10.1111\/anae.15369","type":"journal-article","created":{"date-parts":[[2021,1,14]],"date-time":"2021-01-14T04:00:26Z","timestamp":1610596826000},"page":"1245-1258","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Adjunctive treatments for the management of septic shock \u2013 a narrative review of the current evidence"],"prefix":"10.1111","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3043-446X","authenticated-orcid":false,"given":"K.","family":"Donovan","sequence":"first","affiliation":[{"name":"Adult Intensive Care Unit Oxford University Hospitals NHS Foundation Trust Oxford UK"},{"name":"Adult Intensive Care Unit Oxford University Hospitals NHS Foundation Trust Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1869-2231","authenticated-orcid":false,"given":"A.","family":"Shah","sequence":"additional","affiliation":[{"name":"Adult Intensive Care Unit Oxford University Hospitals NHS Foundation Trust Oxford UK"},{"name":"Radcliffe Department of Medicine University of Oxford Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Day","sequence":"additional","affiliation":[{"name":"Adult Intensive Care Unit and Nuffield Department of Anaesthesia Oxford University Hospitals NHS Foundation Trust Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. 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