Department of Pharmacy, Hennepin County Medical Center, Minneapolis, MN, USA.
Department of Pharmacy, Saint Luke's Hospital of Kansas City, Kansas City, MO, USA.
Ann Pharmacother. 2023 May;57(5):521-526. doi: 10.1177/10600280221118903. Epub 2022 Aug 29.
Current guidelines recommend norepinephrine as the first-line vasopressor in septic shock followed by addition of vasopressin to achieve a goal mean arterial pressure. Limited evidence exists evaluating how the timing of vasopressin addition affects clinical outcomes in septic shock.
The objective of this study was to determine whether the timing of the addition of vasopressin to norepinephrine affects shock resolution.
This was a multi-site, single system, retrospective cohort, institutional review board (IRB)-approved study examining adult patients with septic shock who received norepinephrine and vasopressin. Patients were divided and statistically analyzed in two subgroups: early vasopressin addition (<3 hours) and late vasopressin addition (≥3 hours). The primary outcome was time to shock resolution, defined as vasopressor free for at least 24 hours. Secondary outcomes included norepinephrine dose at 3 hours after initiation of vasopressin, in-hospital mortality, and intensive care unit length of stay.
A total of 243 patients were included in this study. A statistically significant decrease in time to shock resolution was observed in the early vasopressin addition group compared to the late vasopressin addition group (37.6 hours vs 60.7 hours; adjusted hazard ratio [HR]: 2.07 [1.48-2.89; = <0.001]). The early addition of vasopressin did not affect norepinephrine dose or in-hospital mortality but did lead to a decreased intensive care unit (ICU) length of stay (4.3 days vs 5.3 days, = 0.02).
Addition of vasopressin to norepinephrine within 3 hours was associated with a faster time to shock resolution. These findings suggest a potential for improved clinical outcomes with earlier vasopressin addition.
目前的指南建议脓毒性休克患者首先使用去甲肾上腺素作为血管加压药，然后加用血管加压素以达到目标平均动脉压。目前尚缺乏评估血管加压素加用时间对脓毒性休克临床结局影响的证据。
本研究旨在确定去甲肾上腺素加用血管加压素的时机是否影响休克的缓解。
这是一项多地点、单一系统、回顾性队列、机构审查委员会（IRB）批准的研究，纳入了接受去甲肾上腺素和血管加压素治疗的脓毒性休克成年患者。患者分为早期（<3 小时）和晚期（≥3 小时）血管加压素加用亚组，并进行统计学分析。主要结局为休克缓解时间，定义为至少 24 小时无血管加压素。次要结局包括血管加压素开始后 3 小时的去甲肾上腺素剂量、院内死亡率和重症监护病房（ICU）住院时间。
共有 243 例患者纳入本研究。与晚期血管加压素加用组相比，早期血管加压素加用组的休克缓解时间明显缩短（37.6 小时 vs 60.7 小时；调整后的危险比[HR]：2.07[1.48-2.89]；P<0.001）。早期加用血管加压素不会影响去甲肾上腺素剂量或院内死亡率，但会缩短 ICU 住院时间（4.3 天 vs 5.3 天，P=0.02）。
在 3 小时内将血管加压素加用至去甲肾上腺素中与更快的休克缓解时间相关。这些发现提示早期加用血管加压素可能会改善临床结局。
