Earlier vasopressin add-on tied to lower mortality in septic shock

A target trial emulation using MIMIC-IV and eICU-CRD databases compared starting adjunctive vasopressin within 0-3 hours versus 3-6 hours after norepinephrine reached 0.25 mcg/kg/min or higher in septic shock patients. The study reported that ultra-early initiation was associated with lower weighted 28-day mortality (48.1% vs 53.0%, risk difference -5.0 percentage points) and reduced rates of renal replacement therapy, continuous renal replacement therapy, and medically treated arrhythmia, though not reduced acute kidney injury. The authors note this is an observational emulation of a trial rather than a randomized study.

Most relevant for: Adults with septic shock requiring norepinephrine infusion rates of 0.25 mcg/kg/min or higher prior to vasopressin use, typically managed in the ICU.

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