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Cited by 1,924Sepsis Diagnosis and TreatmentHemodynamic Monitoring and TherapyAbdominal Surgery and Complications

The DOI matches its Crossref record; 37 of the 37 references it cites were found in a registry or an index.

Vasopressin versus Norepinephrine Infusion in Patients with Septic Shock

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Russell, James A., Walley, Keith R., Singer, Joel, Gordon, Anthony C., Hébert, Paul C., Cooper, D. James, Holmes, Cheryl L., Mehta, Sangeeta, Granton, John T., Storms, Michelle M., Cook, Deborah J., Presneill, Jeffrey J., Ayers, Dieter·2008·New England Journal of Medicine
DOI 10.1056/nejmoa067373
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Abstract

BACKGROUND: Vasopressin is commonly used as an adjunct to catecholamines to support blood pressure in refractory septic shock, but its effect on mortality is unknown. We hypothesized that low-dose vasopressin as compared with norepinephrine would decrease mortality among patients with septic shock who were being treated with conventional (catecholamine) vasopressors. METHODS: In this multicenter, randomized, double-blind trial, we assigned patients who had septic shock and were receiving a minimum of 5 microg of norepinephrine per minute to receive either low-dose vasopressin (0.01 to 0.03 U per minute) or norepinephrine (5 to 15 microg per minute) in addition to open-label vasopressors. All vasopressor infusions were titrated and tapered according to protocols to maintain a target blood pressure. The primary end point was the mortality rate 28 days after the start of infusions. RESULTS: A total of 778 patients underwent randomization, were infused with the study drug (396 patients received vasopressin, and 382 norepinephrine), and were included in the analysis. There was no significant difference between the vasopressin and norepinephrine groups in the 28-day mortality rate (35.4% and 39.3%, respectively; P=0.26) or in 90-day mortality (43.9% and 49.6%, respectively; P=0.11). There were no significant differences in the overall rates of serious adverse events (10.3% and 10.5%, respectively; P=1.00). In the prospectively defined stratum of less severe septic shock, the mortality rate was lower in the vasopressin group than in the norepinephrine group at 28 days (26.5% vs. 35.7%, P=0.05); in the stratum of more severe septic shock, there was no significant difference in 28-day mortality (44.0% and 42.5%, respectively; P=0.76). A test for heterogeneity between these two study strata was not significant (P=0.10). CONCLUSIONS: Low-dose vasopressin did not reduce mortality rates as compared with norepinephrine among patients with septic shock who were treated with catecholamine vasopressors. (Current Controlled Trials number, ISRCTN94845869 [controlled-trials.com].).

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  1. Argenziano M, 1997, Circulation, 96, II
  2. Chen JM, 1999, Circulation, 100, II

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Metadata

Authors
Russell, J. A., Walley, K. R., Singer, J., Gordon, A. C., Hébert, P. C., Cooper, D. J., Holmes, C. L., Mehta, S., Granton, J. T., Storms, M. M., Cook, D. J., Presneill, J. J., & Ayers, D.
Affiliations
  • St. Paul's Hospital (CA)
  • University of Ottawa (CA)
  • The Alfred Hospital (AU)
  • University of British Columbia (CA)
  • Mount Sinai Hospital (CA)
  • University of Toronto (CA)
  • McMaster University (CA)
  • The Royal Melbourne Hospital (AU)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2008-02-28
Volume
358
Issue
9
Pages
877-887
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa067373
OpenAlex
W2108153775
Cited by
1,924
References
36
Citations by year
2026: 106 · 2025: 119 · 2024: 101 · 2023: 91 · 2022: 88 · 2021: 85 · 2020: 104 · 2019: 205 · 2018: 114 · 2017: 104 · 2016: 100 · 2015: 83 · 2014: 91 · 2013: 84 · 2012: 89
FWCI
88.86
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
Canadian Institutes of Health Research
Topics
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
  • Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
  • Health Sciences › Medicine › Surgery › Abdominal Surgery and Complications
Keywords
septic shock, vasopressin, norepinephrine, vasopressor therapy, catecholamines, mortality, 28-day mortality, 90-day mortality, sepsis treatment, blood pressure support, adverse events, subgroup analysis
MeSH terms
Adult, Aged, Blood Pressure, Catecholamines, Double-Blind Method, Drug Therapy, Combination, Female, Humans, Infusions, Intravenous, Male, Middle Aged, Norepinephrine, Severity of Illness Index, Shock, Septic, Vasoconstrictor Agents, Vasopressins, Treatment Failure, Kaplan-Meier Estimate

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