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In most intensive care units (ICUs), patients are supported with norepinephrine, with further agents added for progressive hypotension. Although vasopressin is used commonly as a second-line vasopressor, its activity on multiple vasopressin receptors might lead to adverse effects. Selepressin (which is currently not FDA approved) acts only on the V1a vasopressin receptor (responsible for vasoconstriction), and this selective activity might be more beneficial than the broad activity of vasopressin.
Investigators randomized 828 patients with septic shock who were being treated with moderate-dose norepinephrine to receive added selepressin or placebo (mean study-drug duration, 38 hours). No significant difference was found in any key endpoint (…