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The following is a summary of “Hemodynamic effects of adjunct arginine vasopressin to norepinephrine in septic shock: insights from a prospective multicenter registry study,” published in the April 2025 issue of Annals of Intensive Care by Melchers et al.
The Surviving Sepsis Campaign guidelines recommended adding arginine vasopressin (AVP) when norepinephrine (NE) doses reached 0.25–0.50 µg/kg/min in patients with septic shock, though solely relying on this NE threshold had limitations, as other factors could influence AVP therapy.
Researchers conducted a retrospective study to identify additional patient characteristics associated with hemodynamic responsiveness to AVP.
They assessed patients in ICU who met the predefined criteria for septic shock (not reaching the individual target mean arterial pressure (MAP) despite adequate fluid resuscitation and NE base dose > 0.25 µg/kg/min) and received AVP therapy. The primary outcome was AVP hemodynamic responsiveness, defined as stabilization or decrease of NE infusion rate 2 hours after initiating AVP. Secondary outcomes included shock duration and rebound hypotension after AVP infusion termination. Univariate and multivariable regression analyses were used to identify associations between patient characteristics and outcomes.
The results showed that between May 2020 and October 2023, 200 patients with septic shock from 11 ICUs were included, with 153 (79%) meeting the definition for AVP hemodynamic responsiveness. Obesity and hyperlactatemia were negatively associated with AVP response (adjusted odds ratio [aOR] 0.30, 95% CI 0.14–0.65 and aOR 0.86, 95% CI 0.75–0.99, respectively). The NE infusion rate ≥ 0.30 µg/kg/min showed positive odds for AVP response (aOR 2.33, 95% CI 1.06–5.14). New-onset atrial fibrillation occurred less frequently in AVP responders than non-responders (4% vs. 14%, p = 0.013). Higher body mass index (BMI), NE infusion rate, and duration before AVP initiation were associated with longer shock duration (aOR 1.06, 95% CI 1.02–1.11, aOR 1.12, 95% CI 1.01–1.25, and aOR 1.01, 95% CI 1.00–1.03, respectively). Higher pH was linked to a lower likelihood of prolonged shock (aOR 0.80, 95% CI 0.64–0.99). Rebound hypotension occurred in 9% after AVP termination, with AVP duration >24 hours negatively associated with rebound hypotension (OR 0.22, 95% CI 0.05–0.85).
Investigators concluded that arterial lactate, pH, BMI, and NE duration and dose were associated with AVP responsiveness and shock duration in septic shock.
Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-025-01472-w
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