Effects of Vasopressin vs. Norepinephrine on Renal Function in Patients with Septic Shock

Data to guide vasopressor choice in treating patients with septic shock are limited. The VASST trial showed no benefit of adding vasopressin to norepinephrine (NEJM JW Infect Dis Apr 2008 and N Engl J Med 2008; 358:877), but smaller studies have suggested improved renal function with early use of vasopressin. In this study, investigators in the U.K. used a 2×2 factorial design to randomize 409 septic shock patients to vasopressin (titrated up to 0.06 U/minute) or norepinephrine (titrated up to 12 µg/minute) as a first vasopressor plus hydrocortisone or placebo as a second intervention for those with persistent shock. Patients were randomized within 6 hours of developing shock, and vasopressors were titrated to maintain a mean arterial press…