Lower vs Higher Vasopressin Threshold Shows No Mortality Benefit in Septic Shock

This cluster-randomized crossover trial across 13 hospitals compared hospital-level strategies initiating vasopressin at a lower norepinephrine-equivalent dose threshold versus a higher threshold in 3959 patients with septic shock. The trial reported no significant difference in 28-day mortality (31.8% vs 33.0%, adjusted OR 0.98, 95% CI 0.87-1.06) or kidney replacement therapy-free days between strategies, despite the lower-threshold strategy resulting in earlier and more frequent vasopressin use.

Most relevant for: Clinicians managing second-line vasopressor selection and timing in adults with septic shock in the ICU or emergency department setting.

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