article199

VASST

"Vasopressin vs Norepinephrine in Septic Shock". The New England Journal of Medicine. Date unknown. Volume and issue unknown: Page numbers unknown. PubMed link•Full text•PDF

Clinical Question

Does low-dose vasopressin reduce mortality among patients with septic shock who are being treated with catecholamine vasopressors compared to norepinephrine?

Bottom Line

Low-dose vasopressin did not reduce mortality rates as compared with norepinephrine among patients with septic shock who were treated with catecholamine vasopressors.

Major Points

Guidelines

Modern guidelines from the ACC/AHA do not comment on the use of antiarrhythmic medications in ACS care.

Design

- Multicenter, randomized, double-blind trial.
- N=778 patients with septic shock on a minimum of 5 μg of norepinephrine per minute.
- Intervention: Low-dose vasopressin (0.01 to 0.03 U per minute) (n=396) vs norepinephrine (5 to 15 μg per minute) (n=382).
- All vasopressor infusions were titrated and tapered to maintain a target blood pressure.

Population

- Patients age 16 and older with septic shock and low-dose norepinephrine.
- Excluded if septic shock was unresponsive to fluids or if specific exclusion criteria were met.

Interventions

- Patients received either low-dose vasopressin or norepinephrine infusion in addition to open-label vasopressors, titrated to maintain target blood pressure.

Outcomes

- Primary: 28-day mortality rate.
- Secondary: 90-day mortality, days free of organ dysfunction, vasopressor use, ventilation, SIRS, corticosteroid use, and length of ICU and hospital stay.
- Serious adverse events.

Criticisms

- Infusion range of vasopressin was fixed, and no adjustments were made based on vasopressin levels.

Funding

- Canadian Institutes of Health Research.