Norepinephrine is currently recommended as the first line vasopressor in septic shocks however early vasopressin use has been proposed as an alternative.
This double blind randomised controlled trial at eighteen UK adult ICUs compared the effect of early vasopressin versus norepinephrine on kidney failure in patients with septic shock. Four hundred patients were randomly assigned to vasopressin and hydrocortisone, vasopressin and placebo, norepinephrine and hydrocortisone or norepinephrine and placebo.
The primary outcome was kidney failure free days during a 28 day period with secondary outcomes including rates of renal replacement therapy, mortality and serious adverse events.
The results showed that the use of vasopressin compared with norepinephrine did not improve the number of kidney failure free days (or the mortality rates or the number of serious adverse events). Thus the finding do not support the use of vasopressin to replace norepinephrine as an initial treatment in this situation though there was a statistically significant reduction in the use of renal replacement therapy.
The article was published in JAMA August 2, 2016, Vol 316, No. 5. The complete abstract and full text (if you have a personal subscription to JAMA) can be accessed via this link or the physical copy can be found in the Healthcare Library of the Hospital.