Hemodynamic effects of adjunct arginine vasopressin to norepinephrine in septic shock: insights from a prospective multicenter registry study
Authors' conclusion
Arterial lactate, pH, BMI, and NE duration and dose were associated with AVP responsiveness and shock duration during septic shock, and rebound hypotension occurred in 9% during recovery.
Study context
- Population
- Adult ICU patients with septic shock (norepinephrine (NE) base dose > 0.25 µg/kg/min, target MAP not reached despite adequate fluid resuscitation) receiving adjunct arginine vasopressin (AVP)
- Participants
- 200 patients · 11 ICUs
- Exposure
- Patient characteristics associated with AVP hemodynamic responsiveness
- AVP respondersn = 153
- Outcome
- AVP hemodynamic responsiveness (stabilization or decrease of NE infusion rate)
- Follow-up
- 2 hours after initiating AVP
Methodological detailsmulticentre, registry, May 2020 to October 2023
- Multicentre
- Registry
- May 2020 to October 2023
Main finding
As reported in the abstract
AVP hemodynamic responsiveness (stabilisation or decrease of NE infusion rate 2 h after AVP start) · 2 h after AVP initiation
AOR for AVP response (95% CI)
Obesity
0.30(0.14–0.65)
Hyperlactatemia
0.86(0.75–0.99)
NE infusion rate ≥ 0.30 µg/kg/min
2.33(1.06–5.14)
- Met the definition for AVP hemodynamic responsiveness
- 153 (79%)
Observational data: associations, not effects.
Secondary outcomes
Shock duration
| Estimate | ||
|---|---|---|
| Higher BMI | aOR for longer shock duration 1.06 (95% CI 1.02–1.11) | |
| Higher NE infusion rate | aOR for longer shock duration 1.12 (95% CI 1.01–1.25) | |
| Higher pH | aOR for prolonged shock 0.80 (95% CI 0.64–0.99) | |
| 0.512Ratio (log scale) |
Rebound hypotension after AVP termination
| OR for rebound hypotension (95% CI) | ||
|---|---|---|
| AVP duration > 24 h | 0.22 (0.05–0.85) | |
| 0.050.21520OR for rebound hypotension (log scale) |
- Rebound hypotension after AVP termination — Rebound hypotension occurred when AVP terminated
- 9%
Safety
New-onset AF
P = 0.013
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Hemodynamic effects of adjunct arginine vasopressin to norepinephrine in septic shock: insights from a prospective multicenter registry study. Ann Intensive Care. Published 29 April 2025. doi:10.
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