Early vasopressin use does not improve septic shock survival

A new study from researchers at Intermountain Health in Salt Lake City found that starting an advanced medication earlier for critically ill patients with life-threatening septic shock does not improve their survival, shorten hospital stays, or improve their recovery compared with waiting until their condition potentially worsens.

These new research findings provide clinicians with important evidence to guide best-practice treatment decisions for patients with septic shock, a severe form of sepsis that causes dangerously low blood pressure and contributes to an estimated one in three hospital deaths nationwide.

Sepsis is also a leading cause of intensive care unit admissions and one of the most expensive conditions treated in U.S. hospitals, costing billions to treat annually, so developing best-practice guidelines for treatment is vital, researchers note.

The new Intermountain Health study, published online on October 14 in JAMA, found clinicians can safely wait to see whether a patient's shock worsens before starting vasopressin, a medication that is a naturally occurring hormone, to restore blood pressure when first-line medications related to adrenaline are not enough.

Doctors use medications called vasopressors to tighten blood vessels and raise blood pressure to a safe level, so organs continue to function while they treat the underlying infection.

Ithan D. Peltan, MD, principal investigator of the study and an Intermountain Health critical care physician and researcherThe question wasn't whether vasopressin works. We already know it can help raise blood pressure in patients with septic shock. The question is when it should be added to other vasopressors."

Some critical care clinicians begin vasopressin relatively early when a patient's blood pressure starts to become difficult to control. Others wait until patients need higher doses of other blood pressure medications before adding it.

"This trial directly answers a common bedside question that affects thousands of patients every year: is it safe to wait to see if a patient's sepsis gets worse before giving them costly infusions they may not need? Our study found that it is."

The infrastructure developed for the study is already being used to launch additional clinical trials within Intermountain Health designed to address challenging questions frequently encountered by physicians and nurses at the bedside.

Researchers say the findings will help inform future clinical practice guidelines and provide physicians with greater confidence when making treatment decisions for patients with septic shock.

"In healthcare, findings that show a treatment doesn't need to be used earlier are often just as important as findings that support a new therapy," said Dr. Peltan. "Our study suggests that hospitals can take a more conservative approach, helping deliver effective care while using resources wisely."

Source:

Intermountain Healthcare

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