A Comparison of Initial Monotherapy with Norepinephrine Versus Vasopressin for Resuscitation in Septic Shock

Daley, Mitchell J.; Lat, Ishaq; Mieure, Katherine D.; Jennings, Heath R; Hall, Jesse B.; Kress, John P.

doi:10.1345/aph.1r442

Cited by 28 publications

(24 citation statements)

References 34 publications

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“…This finding is consistent with previous studies, which found that AVP doses of 0.15-0.47 units/min were needed to replace NE as the sole vasoactive agent in patients with septic shock (13,14). Despite promising retrospective data (15,16), monotherapy or early initiation of AVP at doses up to 0.06 units/min appears unlikely to be sufficient to achieve a goal blood pressure in patients with septic shock and adjunctive vasoactive therapy will be needed, which may mask the potential renal benefits of AVP.…”

supporting

confidence: 92%

Did the beneficial renal outcomes with vasopressin VANISH?

2016

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supporting

confidence: 92%

Did the beneficial renal outcomes with vasopressin VANISH?

2016

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“…The scenarios for which there are physiological bases for vasopressin use may represent opportunities for restrictions in the short‐term and research in the intermediate‐to‐long term. These areas included vasopressin use in patients with severe acidemia, low serum lactate concentration, vasopressin as initial monotherapy, and those at risk for renal failure …”

Section: Discussionmentioning

confidence: 99%

“…These areas included vasopressin use in patients with severe acidemia, 20 low serum lactate concentration, 21 vasopressin as initial monotherapy, [22][23][24] and those at risk for renal failure. 24,25 The respondents' increased willingness to recommend vasopressin in patients receiving stress dose steroids when medication cost is considered is in stark contrast to the above.…”

Section: Discussionmentioning

confidence: 99%

Perceptions regarding vasopressin use and practices in septic shock, and cost containment strategies

Hammond

Rech

Daley

et al. 2019

J Am Coll Clin Pharm

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Background Clinician preferences and practices regarding appropriate vasopressin use in light of its increased acquisition cost secondary to rebranding has not been evaluated or described since the most recent iteration of the Surviving Sepsis Campaign Guideline was published. Objective To assess vasopressin cost containment initiatives and pharmacists' opinions regarding appropriate vasopressin use. Methods A scenario‐based survey was distributed to critical care and emergency medicine pharmacists. Responses were characterized using frequency and descriptive statistics. Categorical variables between those who implemented changes (Vasopressin Cost Consideration) and those who did not (Usual Care) were compared using chi‐square or Fisher's exact tests. McNemar's test was used to compare responses in clinical scenarios between Vasopressin Cost Consideration and Usual Care groups. Results Among 1757 pharmacists surveyed, 200 (11.3%) responded. When respondents considered vasopressin cost and evidence (vs evidence alone), fewer respondents would use vasopressin adjunctively with norepinephrine (21% vs 26.6%, P = 0.031), to raise mean arterial pressure compared with epinephrine (65.2% vs 72.3%, P = 0.012), or to reduce norepinephrine infusion rates (71.4% vs 81.4%, P < 0.001), but would use with steroids (62.4% vs 28.3%, P < 0.001). Most (72%) respondents had implemented vasopressin cost containment and/or education initiatives. The Vasopressin Cost Consideration group respondents were more likely to initiate vasopressin at 0.03 units/minute without titrating (47.9% vs 33.9%, P = 0.045). Conclusion Since vasopressin was generically rebranded, most institutions have implemented at least one initiative to reduce vasopressin use and/or educate clinicians about its appropriate use. When vasopressin acquisition costs were considered, pharmacists recommended its use less frequently, particularly in clinical scenarios where its use is controversial.

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“…Penggunaan vasopresin akan lebih cepat meningkatkan MAP daripada menggunakan norepinefrin tunggal dan nilai laktat pada kelompok vasopresin mengalami perbaikan yang lebih baik dibanding dengan norepinefrin pada jam ke-6 resusitasi. 12,13 Berdasar atas beberapa uraian dan penelitian di atas maka peneliti tertarik melakukan penelitian pemberian norepinefrin ditambah plasebo dibanding dengan pemberian norepinefrin ditambah vasopresin terhadap perubahan laktat pada pasien syok septik. Berdasar atas analisis lanjutan repeated ANOVA, dapat dilihat bahwa kadar laktat rata-rata sebelum pemberian terapi (plasebo) dengan laktat rata-rata pada pengamatan kedua (T1) memiliki selisih yang signifikan.…”

Section: Pendahuluanunclassified

Penurunan Kadar Laktat pada Pemberian Norepinefrin dengan Plasebo dan Norepinefrin dengan Adjuvan Vasopresin pada Pasien Syok Septik

Savitri¹,

Lubis²,

Mursin³

2018

jap

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Laktat merupakan faktor prognostik yang digunakan sebagai indikator beratnya keadaan syok septik dan mortalitas. Vasopresor merupakan obat yang dibutuhkan untuk menjaga tekanan perfusi pada hipotensi berat, untuk mencapai hemodinamik yang diinginkan seperti tekanan vena sentral, MAP, pengeluaran urin, dan oksigenasi. Beberapa penelitian menunjukkan penurunan kadar laktat terhadap pemberian norepinefrin dan vasopresin. Penelitian ini menggunakan desain uji double blind, randomized controlled control trial yang dilakukan pada bulan Desember 2016 sampai Februari 2017 di RSUP Haji Adam Malik Medan. Empat puluh pasien syok septik yang memenuhi kriteria inklusi dan tidak termasuk kriteria eksklusi dibagi 2 kelompok, yaitu kelompok yang mendapat norepinefrin dengan plasebo dan kelompok yang mendapat norepinefrin dengan vasopresin. Kadar laktat dinilai pada kedua kelompok pada waktu setelah pemberian 30 mL/kgBB, setelah MAP tercapai target 65 mmHg dengan pemberian norepinefrin, dan 6 jam setelah perlakuan dengan plasebo atau vasopresin. Hasil penelitian menunjukkan kadar laktat pada plasebo dan vasopresin setelah pemberian 30 mL/kgBB, setelah MAP tercapai target 65 mmHg dengan pemberian norepinefrin, dan 6 jam setelah perlakuan didapatkan penurunan kadar laktat yang bermakna (p<0,05). Uji beda penurunan kadar laktat antara plasebo dengan vasopresin didapatkan hasil yang tidak bermakna pada tiga kali pengukuran (p≥0,05). Simpulan, tidak terdapat perbedaan antara plasebo dan vasopresin terhadap penurunan kadar laktat.

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A Comparison of Initial Monotherapy with Norepinephrine Versus Vasopressin for Resuscitation in Septic Shock

Abstract: Vasopressin was noninferior to norepinephrine for the achievement of a MAP goal in the first 6 hours from onset of septic shock. Further prospective analysis is warranted; however, the results are useful for consideration of alternative vasopressors in the setting of drug shortages.

Cited by 28 publications

References 34 publications

Did the beneficial renal outcomes with vasopressin VANISH?

Did the beneficial renal outcomes with vasopressin VANISH?

Perceptions regarding vasopressin use and practices in septic shock, and cost containment strategies

Penurunan Kadar Laktat pada Pemberian Norepinefrin dengan Plasebo dan Norepinefrin dengan Adjuvan Vasopresin pada Pasien Syok Septik

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