Objective
The optimal timing of vasopressin initiation as an adjunctive vasopressor remains unclear. We aimed to study the association between the timing of vasopressin commencement, pre-specified physiological parameters, and hospital mortality.
Design
We conducted a multicentre, retrospective, observational study.
Setting
Twelve ICUs in Queensland, Australia between January 2015 and December 2021.
Participants
Adult patients with septic shock who received vasopressin as an adjunctive vasopressor within 72 hours of ICU admission.
Main Outcome
Hospital mortality.
Results
Overall, 2747 patients fulfilled the inclusion criteria. Of these, 1850 (67%) started vasopressin within six hours of vasopressor therapy start, while 897 (33%) started vasopressin between six hours and 72 hours. APACHE III score, peak lactate, and creatinine were higher in the early start group. Early vasopressin start was independently associated with decreased hospital mortality (aOR = 0.69, 95% CI = 0.57-0.83). Vasopressin infusion start was also associated with an immediate decrease in the noradrenaline-equivalent dose regardless of timing. There was a statistically significant favourable breakpoint at vasopressin start for the course of arterial pH, lactate, heart rate and crystalloid infusion rate (p<0.001).
Conclusions
In patients with septic shock, early adjunctive vasopressin initiation was independently associated with lower hospital mortality. Vasopressin starting at any time was also associated with reduced tachycardia, acidosis, and hyperlactatemia.
White, K. C., Costa-Pinto, R., Chaba, A., McIlroy, P., Senthuran, S., Luke, S., Attokaran, A. G., Garrett, P., Ramanan, M., Tabah, A., Shekar, K., Laupland, K. B., White, H., McCullough, J., Udy, A., Eastwood, G., Bellomo, R., Ramanan, M., Marella, P., . . . Keogh, S. (2024). Timing of adjunctive vasopressin initiation for septic shock patients and hospital mortality: A multicentre observational study. Critical Care and Resuscitation.
Queensland Critical Care Research Network 