In this episode, I’ll discuss how early you should start vasopressin after the norepinephrine infusion rate reaches 0.25 μg/kg/min or higher in a patient with septic shock.
The best time to add vasopressin after norepinephrine in septic shock is still unclear. A group of authors recently published a target trial emulation in order to explore this topic. They compared ultra-early vasopressin initiation within 0 to 3 hours with early initiation within >3 to 6 hours after the norepinephrine infusion rate reached 0.25 μg/kg/min or higher.
Retrospective data from over 3800 adults patients with septic shock who reached the norepinephrine threshold before vasopressin use were used to perform the target trial emulation.
The weighted 28-day mortality risk was 48.1% using the ultra-early strategy and 53.0% using the early strategy, a difference that was statistically significant. Ultra-early initiation was associated with lower renal replacement therapy (HR, 0.68), continuous renal replacement therapy (HR, 0.61), and medically treated arrhythmia (HR, 0.91).
The authors concluded:
Among adults with septic shock whose norepinephrine infusion reached 0.25 μg/kg/min or higher before vasopressin use, vasopressin initiation within 0–3 h was associated with lower 28-day mortality than initiation within > 3–6 h. this is important information on the timing of vasopressin initiation and represents the best available data to date on the topic.
This data suggests that the timing of starting vasopressin might matter, rather than simply whether or not it is used at all once the norepinephrine infusion rate reaches 0.25 μg/kg/min or higher.
The article in this episode is a selection from my Hospital Pharmacy Academy’s weekly literature digest. Have you ever felt like your physician colleagues are one step ahead of you with new literature developments? Every week, Academy members are provided a summary curated and explained by me of the top hospital pharmacy-related articles published that week from over 20 major journals and sources to save you time and keep you up to date with the literature. To get immediate access, go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
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