Vasopressin in septic shock: what we know and where to next?

Excerpt

Noradrenaline is the vasopressor administered most commonly to patients with distributive shock [1]. However, in one study, 17.2% of patients with septic shock in United States hospitals received vasopressin, usually in combination with catecholamines [2]. In the Adjunctive Glucocorticoid Therapy in Patients with Septic Shock (ADRENAL) trial [3], which included patients from Australia, the United Kingdom, New Zealand, Saudi Arabia, and Denmark, usage was similar with 16.8% of patients receiving vasopressin at baseline. On the other hand, in the Activated Protein C and Corticosteroids for Human Septic Shock (APROCCHSS) trial, an European trial, only 0.08% of patients were receiving vasopressin at baseline [4]. Such variability in usage reflects uncertainty. Accordingly, the individual patient data (IPD) meta-analysis in this issue by Nagendran and colleagues including randomized clinical trials (RCTs) comparing vasopressin with noradrenaline in patients with septic shock is both timely and informative [5]. …