Vasopressor use in septic shock: an update.
OBJECTIVE
This article reviews new findings on the use of vasopressor agents in septic shock.


RESULTS
Several recent large randomized clinical trials have compared vasopressor agents in patients with septic shock. Briefly, the survival of patients treated with norepinephrine alone or a combination of norepinephrine and dobutamine did not significantly differ from that of patients treated with epinephrine. In observational studies, dopamine use was associated with poor outcome. The results of a clinical trial comparing dopamine and norepinephrine as a first-line agent in septic shock are pending. The addition of low-dose vasopressin to norepinephrine did not significantly improve the survival of patients with septic shock. A positive effect on survival was observed in a predetermined (norepinephrine dose <15 microg/kg/min) subgroup of patients with moderate shock. There is no large randomized clinical trial on the use of terlipressin. In contrast, nitric oxide inhibitors were associated with increased mortality in patients with septic shock.


CONCLUSIONS
The use of norepinephrine or epinephrine can be left to the discretion of the treating physician. Low-dose vasopressin administration remains an option for catecholamine-refractory septic shock. The potential benefit of early use in combination with a moderate dose of norepinephrine remains to be determined.
Leone
Marc
M
Département d'Anesthésie et de Réanimation et Centre de Traumatologie, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Marseille, Cedex 20, France. marc.leone@ap-hm.fr
Martin
Claude
C
D006801:Humans; D012151:Resuscitation; D012772:Shock, Septic / Q000188:drug therapy* / Q000503:physiopathology; D013564:Sympathetic Nervous System / Q000503:physiopathology; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D014667:Vasopressins / Q000627:therapeutic use
D014662:Vasoconstrictor Agents; D014667:Vasopressins