ICU Management & Practice, Volume 16 - Issue 3, 2016

Study: Vasopressin vs. Norepinephrine in Septic Shock

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A multicentre trial investigating early use ‏of vasopressin compared to norepinephrine ‏to treat septic shock found no reduction ‏in the number of kidney failure-free days. The ‏results of the VAsopressin vs. Noradrenaline as ‏Initial therapy in Septic sHock (VANISH) trial ‏are published in JAMA (Gordon et al. 2016). ‏

 

Patients who had septic shock requiring ‏vasopressors despite fluid resuscitation within ‏a maximum of 6 hours after the onset of shock ‏were randomised to vasopressin and hydrocortisone ‏(n=101), vasopressin and placebo ‏(n=104), norepinephrine and hydrocortisone ‏(n=101), or norepinephrine and placebo ‏(n=103). The primary outcome was kidney ‏failure-free days during the 28-day period ‏after randomisation, namely the proportion of ‏patients who never developed kidney failure and ‏the median number of days alive and free of ‏kidney failure for patients who did not survive, ‏who experienced kidney failure, or both.

 

Early use of vasopressin compared with ‏norepinephrine did not improve the number ‏of kidney failure-free days. However, the confidence ‏interval included a potential clinically ‏important benefit for vasopressin, and larger ‏trials may be warranted to assess this further, ‏the authors write. Prof. Anthony Gordon, (pictured) Imperial ‏College London, the trial’s Chief Investigator, ‏told ICU Management and Practice that this potential ‏benefit was related to the secondary outcomes ‏measured in the trial, which related to kidney ‏function: fewer patients in the vasopressin group ‏needed renal replacement therapy, and they had ‏greater urine output and lower creatinine levels ‏over the first week. Gordon said that the results ‏will probably not change routine first-line ‏pressors for septic shock, i.e. norepinephrine. ‏However, clinicians may consider starting vasopressin ‏early in patients whose kidney function ‏is deteriorating.

 

Results

409 patients (median age, 66 years)

Median time to study drug administration: 3.5 hours ‏after diagnosis of shock

 

Vasopressin group

Survivors who never developed kidney failure: ‏94/165 (57%)

Median number of kidney failure-free days for patients who did not survive, who experienced kidney ‏failure: 9 days

 

Norepinephrine group

Survivors who never developed kidney failure: ‏93/157 patients (59%)

Median number of kidney failure-free days for patients ‏who did not survive, who experienced kidney ‏failure: 13 days ‏


References:

Gordon AC, Mason AJ, Thirunavukkarasu N, Perkins GD, Cecconi ‏M, Cepkova M, Pogson DG, Hollman DA, Anjum A, Frazier GJ, ‏Santhakumaran S, Ashby D, Brett SJ (2016) Effect of earlyvasopressin ‏vs norepinephrine on kidney failure in patients with ‏septicshock. JAMA, 316(5): 509-18. doi:10.1001/jama.2016.10485 ‏




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Study: Vasopressin vs. Norepinephrine in Septic Shock Study: Vasopressin vs. Norepinephrine in Septic Shock

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