VASST
Trial question
What is the role of vasopressin among patients with septic shock who were treated with catecholamine vasopressors?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
39.0% female
61.0% male
N = 779
779 patients (304 female, 475 male).
Inclusion criteria: patients who had septic shock and were receiving a minimum of 5 mcg of norepinephrine per minute.
Key exclusion criteria: anticipated death in 12 months, > 24 hours since the meeting of inclusion criteria, pregnancy, chronic heart disease, unstable angina or MI within the previous 30 days, acute mesenteric ischemia, severe hyponatremia, Raynaud's phenomenon, systemic sclerosis, traumatic brain injury.
Interventions
N=397 vasopressin (at a dose of 0.01-0.03 U/min plus open-label vasopressors).
N=382 norepinephrine (at a dose of 5-15 mcg/min plus open-label vasopressors).
Primary outcome
Death at day 28
35.4%
39.3%
39.3 %
29.5 %
19.6 %
9.8 %
0.0 %
Vasopressin
Norepinephrine
No significant
difference ↔
No significant difference in death at day 28 (35.4% vs. 39.3%; RR 0.9, 95% CI 0.75 to 1.08).
Secondary outcomes
No significant difference in death at day 90 (43.9% vs. 49.6%; RR 0.88, 95% CI 0.76 to 1.03).
No significant difference in length of stay in the ICU (15 days vs. 16 days; AD -1 days, 95% CI -2.33 to 0.33).
No significant difference in length of stay in the hospital (27 days vs. 26 days; AD 1 days, 95% CI -0.63 to 2.63).
Safety outcomes
No significant difference in serious adverse events.
Significant differences in cardiac arrest (0.8% vs. 2.1%), digital ischemia (2.0% vs. 0.5%).
Conclusion
In patients who had septic shock and were receiving a minimum of 5 mcg of norepinephrine per minute, vasopressin was not superior to norepinephrine with respect to death at day 28.
Reference
James A Russell, Keith R Walley, Joel Singer et al. Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med. 2008 Feb 28;358(9):877-87.
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