Low-Dose Vasopressin in Septic Shock

Low-Dose Vasopressin No Better Than Norepinephrine in Septic Shock

Low-dose vasopressin does not provide a survival advantage over norepinephrine in refractory septic shock, according to a New England Journal of Medicine study.

Researchers studied almost 800 patients with septic shock unresponsive to initial fluid therapy and low-dose norepinephrine. Patients were randomized in a double-blind fashion either to low-dose vasopressin (0.01-0.03 U/min) or to norepinephrine (5-15 μg/min). All patients could continue to receive open-label catecholamine vasopressors as well.

There was no advantage to either regimen at 28 or 90 days after first infusions with regard to survival, rates of organ dysfunction, or rates of serious adverse events.

An editorialist writes: "Although adding vasopressin ... appears to produce similar mortality rates [as norepinephrine] and is safe, there is no compelling advantage to using vasopressin rather than norepinephrine."

http://content.nejm.org/cgi/content/short/358/9/877