Kristen Lopatofsky, BCCCP, PharmD
Acute Care Clinical Pharmacist
Geisinger Wyoming Valley Medical Center
Wilkes Barre, Pennsylvania
Disclosure information not submitted.
Nicholas Preston, PharmD
Acute care clinical pharmacist
Geisinger Medical Center, United States
Disclosure information not submitted.
Kayla Kotch, PharmD, BCCCP
Acute care clinical pharmacist, Critical care pharmacy coordinator
Geisinger Wyoming Valley Medical Center, United States
Disclosure information not submitted.
Title: Methods of Vasopressor Weaning in Recovering Septic Shock
Introduction: Currently, the 2016 Surviving Sepsis Campaign (SSC) guidelines provide recommendations on initiating vasopressors but remain silent on a recommended method to discontinue vasopressors in patients with resolving septic shock. There is a paucity of data providing conflicting results on the best approach for vasopressor weaning. This study aimed to identify if discontinuing norepinephrine (NE) prior to vasopressin (AVP) in patients with septic shock results in a lower risk of rebound hypotension.
Methods: Medical records of patients admitted to a Geisinger intensive care unit (ICU) with a diagnosis of septic shock receiving both NE and AVP from January 1, 2015 to February 28, 2020 were reviewed. Use of other vasopressors, steroids, thiamine, and vitamin C, dose of NE and AVP at the start of vasopressor weaning, ICU discharge, and hospital discharge were collected. Patients were assessed for rebound hypotension, in-hospital mortality, and ICU and hospital length of stay.
Results: A total of 992 patients were included in this study. There was no difference between rates of rebound hypotension among patients weaned from NE compared to AVP (61.6% vs 59.9%, p = 0.5904). Rates of in-hospital mortality were also similar between weaning NE first and AVP first (35.9% vs 39.5%, p = 0.241). There was a significant difference in average hospital length of stay (416.4 hours vs 482.9 hours, p = 0.012) and ICU length of stay (241.2 hours vs 299.1 hours, p = 0.003) between weaning NE first compared to AVP.
Conclusions: Discontinuation of NE prior to AVP did not result in significantly less rates of rebound hypotension or mortality, though there was a significantly reduced hospital and ICU length of stay. Further prospective studies and larger systematic reviews are needed to determine the best method of vasopressor weaning due to conflicting results.