title: Does vasopressin improve the mortality of septic shock patients treated with high-dose NA.
abstract: OBJECTIVE
  In Surviving Sepsis Campaign Guidelines 2012, noradrenalin (NA) is recommended as a first choice vasopressor. Although vasopressin (VP) is recommended for the treatment of NA-resistant septic shock, the optimal parameters for its administration remain unclear.
  
  
  METHODS
  We conducted a retrospective study to evaluate the clinical outcomes of the administration of VP to adult septic shock patients who were undergoing high-dose NA (≥0.25 μg/kg/min) therapy in our Intensive Care Unit between January 2010 and December 2013. We defined high-dose NA as a dose of >0.25 μg/kg/min, based on the definition of low-dose NA as a dose of 5-14 μg/min because the average body weight of the patients in this study was 53.0 kg.
  
  
  RESULTS
  Among 29 patients who required the administration of high-dose NA, 18 patients received VP. Although the patient background physiological conditions and NA dose did not differ between the two groups, the survival rate of the VP-treated patients was significantly lower (33%) than that of the patients who were managed with a high-dose of NA-alone (82%) (P = 0.014). The lactate clearance did not change after the administration of VP, whereas it improved when in NA treatment alone.
  
  
  CONCLUSIONS
  The results suggest that the administration of VP did not improve the mortality among septic shock patients when administered in addition to high-dose NA.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Ohsugi
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Kotani
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Fukuda
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Department of Anesthesiology, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Toyama
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Ozaki
keywords: Lactate clearance; noradrenalin; septic shock; vasopressin