Vasopressin use in septic shock and effect on mortality.
Hadid H, DiGiovine B, and Jennings JH. Vasopressin use in septic shock and effect on mortality. Am J Respir Crit Care Med 2018; 197.
American journal of respiratory and critical care medicine
Vasopressin use in shock and effect on mortality Background: Septic shock is a leading cause of mortality in the United States. Hemodynamic support with intravenous vasopressors such as norepinephrine have been associated with reduced mortality. Whilevasopressin has emerged as an adjunct vasoconstrictor in the treatment of these septic patients, its effect on mortality remains uncertain. In our institution, the routine use of vasopressin was restricted in 2014 due to cost. We hypothesized that decreased access to vasopressin would have no effect on mortality in patients with septic shock. Methods:Our study included 1257 consecutive patientswith septic shock and requiring vasopressors who were admitted between 1/1/2014 and 6/29/2016. Of these, 557 were admitted after 1/1/2014 but prior to 9/1/2014, when vasopressin was still widely available (pregroup). The remaining 700 patients were admitted between 9/1/2014 and 6/29/2016, when vasopressin use was restricted (post-group). Patients >18 years of age with admission diagnosis of septic shock requiring at least 5 mcg/min of norepinephrine were included. Regression was used to control for confounders including severity of illness and doses of vasopressors. Results: 1257 consecutive patients assessed for the study period (pre-group n=557, post-group n=700). Mean norepinephrine levels were lower in the pre-group (35 vs 49 mcg/min respectively, pvalue= 0.047) while more patients in the post-group receiveda secondary agent, epinephrine. (10.6% vs. 4.7% respectively, p < 0.001). There was no difference in overall mortality between groups, after controlling for severity of illness (OR [95% CI], 0.861 [0.68-1.08]; p=0.202). Similarly, there was no difference in mortality in a subgroup of patients on higher doses of norepinephrine (OR [95% CI], 0.802 [0.61-1.06]; p=0.123). Conclusion: There was no difference in mortality for patients treated for septic shock in our ICU regardless of the restriction of vasopressin. In addition, sub-group analysis suggests that resorting to epinephrine in absence of vasopressin had no impact on mortality. Our study results are consistent with previous trials that did not find a mortality difference with the use of vasopressin.