Abstract | OBJECTIVE: DESIGN: SETTING: Twenty-seven Intensive Care Units in Canada, Australia, and the United States. PATIENTS: INTERVENTIONS: Patients were randomized to blinded vasopressin (0.01-0.03 units/min) or norepinephrine (5-15 microg/min) infusion added to open-label vasopressors. Corticosteroids were given according to clinical judgment at any time in the 28-day postrandomization period. MEASUREMENTS: The primary end point was 28-day mortality. We tested for interaction between vasopressin treatment and corticosteroid treatment using logistic regression. Secondary end points were organ dysfunction, use of open-label vasopressors and vasopressin levels. MAIN RESULTS: There was a statistically significant interaction between vasopressin infusion and corticosteroid treatment (p = 0.008). In patients who had septic shock and were also treated with corticosteroids, vasopressin, compared to norepinephrine, was associated with significantly decreased mortality (35.9% vs. 44.7%, respectively, p = 0.03). In contrast, in patients who did not receive corticosteroids, vasopressin was associated with increased mortality compared with norepinephrine (33.7% vs. 21.3%, respectively, p = 0.06). In patients who received vasopressin infusion, use of corticosteroids significantly increased plasma vasopressin levels by 33% at 6 hours (p = 0.006) to 67% at 24 hours (p = 0.025) compared with patients who did not receive corticosteroids. CONCLUSIONS:
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Authors | James A Russell, Keith R Walley, Anthony C Gordon, D James Cooper, Paul C Hébert, Joel Singer, Cheryl L Holmes, Sangeeta Mehta, John T Granton, Michelle M Storms, Deborah J Cook, Jeffrey J Presneill, Dieter Ayers for the Vasopressin and Septic Shock Trial Investigators |
Journal | Critical care medicine
(Crit Care Med)
Vol. 37
Issue 3
Pg. 811-8
(Mar 2009)
ISSN: 1530-0293 [Electronic] United States |
PMID | 19237882
(Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Adrenal Cortex Hormones
- Vasopressins
- Hydrocortisone
- Norepinephrine
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Topics |
- Adrenal Cortex Hormones
(therapeutic use)
- Drug Synergism
- Female
- Humans
- Hydrocortisone
(therapeutic use)
- Male
- Middle Aged
- Norepinephrine
(administration & dosage)
- Shock, Septic
(drug therapy, mortality)
- Single-Blind Method
- Vasopressins
(administration & dosage)
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