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• W4313235937 abstract "Introduction: Optimal timing of vasopressin addition to norepinephrine remains undetermined in patients with septic shock. Current sepsis guidelines recommend the early addition of vasopressin when the norepinephrine dose is between 0.25 and 0.5 mcg/kg/min. We aimed to determine if early vasopressin would result in more vasopressor-free days. Methods: A retrospective chart review was conducted in 200 patients hospitalized with septic shock treated with vasopressin. We defined the early vasopressin group (EVP) as vasopressin initiated when norepinephrine ≤0.25 mcg/kg/min, and the late vasopressin group (LVP) as vasopressin initiated when norepinephrine >0.25 mcg/kg/min. Groups were stratified by maximum norepinephrine equivalents (NEE) requirement during ICU stay. Subgroups were < 0.1 mcg/kg/min NEE, 1.0-2.0 mcg/kg/min NEE, and >2.0 mcg/kg/min NEE to give a fair comparison of severity of illness. The primary outcome was vasopressor-free days. Patients who expired during hospitalization were given 0 vasopressor-free days. Results: A total of 200 patients were included, 100 in the EVP group and 100 in the LVP group. Baseline characteristics were similar between groups except for female sex, which was higher in the EVP group (52% vs 29%, p< 0.001) and baseline lactate levels were higher in the LVP group (7.11 vs 4.82, p< 0.01). APACHE II scores were similar between groups (EVP 28±6 vs LVP 28±7, p=0.47). Average vasopressor-free days was 7±8 in the EVP group and 6±12 in the LVP group (p< 0.05), NEE subgroups showed no difference. Need for renal replacement therapy was higher in the EVP group (30% vs 19%, p< 0.05). Overall, in-hospital mortality in EVP group was 72% vs 84% in LVP group (p< 0.05). New onset atrial fibrillation was higher in the LVP group (30% vs 16%, p< 0.05). Ventilator-free days, mesenteric and digital ischemia, hospital-, and ICU-length of stay were similar between groups. Conclusions: In this retrospective cohort study, patients with early vasopressin initiation had significantly more vasopressor-free days relative to the late group. Mortality in both groups was higher than expected, suggesting a high severity of illness in our patient population." @default.
• W4313235937 created "2023-01-06" @default.
• W4313235937 creator A5019353496 @default.
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• W4313235937 date "2022-12-15" @default.
• W4313235937 modified "2023-09-24" @default.
• W4313235937 title "1218: EARLY VERSUS LATE INITIATION OF VASOPRESSIN IN SEPTIC SHOCK" @default.
• W4313235937 doi "https://doi.org/10.1097/01.ccm.0000910608.31871.bf" @default.
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