Scientific Poster Session III - Original Research

Abstract

Society of Critical Care Medicine (SCCM) recommends use of vasoactive medications to maintain adequate mean arterial pressure (MAP) in septic shock. Norepinephrine (NE) is recommended as a first-line vasopressor followed by vasopressin (AVP) if MAP goal is not achieved. Although the guidelines are specific on the order of NE and AVP initiation, there is less clarity on weaning order. Additionally, there is conflicting literature on which vasopressor to wean first.

Research Question or Hypothesis:

Is there a difference in incidence of hypotension depending on the order of vasopressor discontinuation?

Study Design:

Single center, retrospective cohort study from January 2019 to December 2022.

Methods:

Patients > 18 years of age admitted to the ICU receiving concurrent NE and AVP infusions for septic shock were included. Patients excluded if they had a diagnosis of mixed shock or were on other parenteral vasoactive therapy at the time of NE or AVP weaning. Primary outcome was incidence of hypotension at 6, 12 and 24 hours. Secondary outcomes were hospital and ICU mortality, vasoactive medication duration, and incidence of acute kidney . Categorical variables are summarized as frequencies and percentages and Continuous variables are summarized as means and standard deviations

Results:

Total of 42 patients (NE=27, AVP= 15) included in the analysis. Baseline demographics were similar in both arms. There was no statistically significant difference in the incidence of hypotension between the groups and any of the prespecified time points. In-hospital mortality was statistically significant higher in patients who were weaned from NE first (p=0.042).

Conclusion:

This is the first analysis to show order of vasopressor weaning showed no statistical difference in the occurrence of hypotension. The order of vasopressor discontinuation may affect in-hospital mortality rates in patients when NE is weaned prior to AVP. More patient data is needed for further evaluation.

Presenting Author

Authors