Earlier Vasopressin Initiation Improves Outcomes in Septic Shock

Background: For adults with septic shock, survivingsepsis.org recommends norepinephrine (NE) as the first-line vasopressor and recommends vasopressin as the second-line agent, suggesting the initiation of vasopressin after a dose of 0.25 to 0.5 μg/kg per min of NE is reached. Previous studies have varied regarding the possible benefits of early vasopressin institution; however, in general, vasopressin seems to be more frequently added to NE in approximately one-third of cases, and the use seems to be rising. Objective: To determine the relationship between NE dose, lactate concentration, and time duration of shock at vasopressin initiation with in-hospital mortality from septic shock. Design: Retrospective observational study. Methods: Evaluation of 2 large medical databases of adult patients receiving continuous catecholamine infusions for septic shock by Sepsis-3 criteria was done. A total of 9871 patients with Sepsis-3 criteria were investigated, of whom 1409 patients from 209 hos more...