THURSDAY, Oct. 22, 2026 (HealthDay News) -- A strategy recommending initiation of vasopressin at a lower dose of other vasopressors does not reduce 28-day mortality for patients in septic shock, according to a study published online Oct. 14 in the Journal of the American Medical Association.
Ithan D. Peltan, M.D., from Intermountain Medical Center in Murray, Utah, and colleagues compared the effects of hospital-level strategies initiating vasopressin infusion at a lower versus higher threshold on outcomes in 3,959 unique patients with septic shock in a cluster-randomized, pragmatic clinical strategy trial. The intervention involved implementation of septic shock management strategies recommending fixed-dose vasopressin initiation when the total dose of other vasopressors reached 0.1 μg/kg/min (lower-threshold strategy) or 0.4 μg/kg/min of norepinephrine or equivalent (higher-threshold strategy).
The researchers found that of the patients more likely to experience differential management under the tested hospital-level vasopressin dose strategies, 68.0 and 42.7 percent cared for under the lower- and higher-threshold strategies, respectively, received vasopressin. The maximum vasopressor dose received prior to vasopressin initiation was a median of 0.14 versus 0.34 μg/kg/min of norepinephrine or equivalent in the hospital-level strategy recommending a lower- versus a higher-dose threshold for vasopressin initiation. Twenty-eight-day mortality occurred in 31.8 and 33.0 percent of patients treated with the hospital-level strategy recommending initiation of vasopressin at a lower- versus higher-dose threshold of other vasopressors, respectively. In both strategies for vasopressin initiation, there were a median of 29 kidney replacement therapy-free days.
"Our study suggests that hospitals can take a more conservative approach, helping deliver effective care while using resources wisely," Peltan said in a statement.
Several authors disclosed ties to the biopharmaceutical industry.
