Brandon Nance, DO
Franciscan Health Olympia Fields
Olympia Fields, Illinois
Disclosure information not submitted.
Sara Wong, DO
Critical Care Physician
Glendale, CA, United States
Disclosure information not submitted.
Ravi Sundaram, DO
Intensivist/ Pulmonologist
Franciscan Saint James Health, United States
Disclosure information not submitted.
Title: Early Addition of Vasopressin to Norepinephrine in Septic Shock
Introduction: Previous studies have shown that vasopressin is deficient in septic shock. Various studies have evaluated the benefits in the early addition of vasopressin to norepinephrine in septic shock patients. We hypothesize that the addition of vasopressin at a dose of 20 mcg norepinephrine (our institutions protocol) decreases time on norepinephrine.
Methods: Adult patients hospitalized at a single center who required vasopressin during the months of December 2018 to May 2019 were included in this retrospective cohort study. Pregnant patients and those young than 18 years of age were excluded. The primary outcomes were total hours on norepinephrine with secondary outcomes including days to death, ICU and hospital discharge.
Results: During the six month period a total of 55 patients received vasopressin. No patients were excluded. The patients were nearly evenly split in those who received ≤20 mcg 24 patients (44%) and those who received >20 mcg 31 patients (57%). The average age was 71 (34-99) and gender was nearly evenly split w/ 23 males (42%) and 32 females (58%). The median time on norepinephrine was 81H (1-516). APACHE II scores were calculated, which serve as a morality predictor, which was >25 in 27 (49%) of the patients between both groups. The secondary outcomes included 20 patients in the time to ICU and hospital discharge groups with 34 patients in the time to death group. The mean hours on norepinephrine was 85H (range 1-516) for the ≤20 mcg group and 56H (range 3-240) for the >20 mcg group (p-value 0.2036). Days to ICU discharge was 9 days (range 1-15) in the ≤20mcg group and 3.9 days (range 1-10) in the >20mcg group (p-value 0.0277). Days to hospital discharge had a mean of 13.8 days (range 1-33) in the ≤20 mcg group and 13.1 days ( range 1-34) in the >20 mcg group (p-value 0.9999). The days to death had a mean of 9 days (range 1-22) in the ≤20 mcg group and 6.9 days (range 0.25-27) in the >20 mcg group (p-value 0.1640).
Conclusions: Despite prior studies demonstrating the benefits of the addition of vasopressin at lower doses of norepinephrine. There was no significant difference in time on norepinephrine between the two groups.