Vasopressin Hemodynamic Response as a Septic Shock Subphenotype Indicator

Launched by THE CLEVELAND CLINIC · May 17, 2024

Keywords

ClinConnect Summary

Septic shock mortality remains high at 33% in North America; current clinical predictors of poor outcomes in septic shock are suboptimal. In addition to antibiotics and intravenous fluids, vasoactive agents are initiated to restore effective tissue perfusion. Norepinephrine (NE) is the recommended first-line vasopressor, but adjunctive arginine vasopressin is used in over one-third of patients to improve blood pressure or decrease NE dosage. However, less than half of vasopressin recipients have a clinically-apparent hemodynamic response (defined as a decrease in NE dosage at 6 hours after ...

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Adult patients (≥18 years old)
• • Septic shock (as defined by Sepsis-3)
• • Receiving norepinephrine
• • Admitted to a medical, surgical, NeuroSciences, or mixed intensive care unit
• • Central venous catheter in place
• • Ordered fixed-dose vasopressin as an adjunct to norepinephrine by the primary care team (unless in active control cohort)
• Exclusion Criteria:
• • Vasopressin ordered for an indication other than septic shock
• • Vasopressin initiated at another institution
• • Receiving a primary vasopressor other than norepinephrine (eg, phenylephrine)
• • Positive test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within the preceding 28 days
• • Blood hemoglobin concentration \<7 g/dL
• • Primary treatment team determines that vasopressin initiation is emergent
• • Patient or their legal authorized representative opts to not participate in the study

Trial Officials