Effect of Vasopressin Initiation Threshold on Septic Shock Mortality: The VASSPR Cluster Crossover Randomized Strategy Trial.

Lower-threshold vasopressin initiation in septic shock does not significantly change 28-day mortality compared to higher-threshold initiation, with mortality rates of 31.8% versus 33.0%.

• Why it matters: Determining the optimal vasopressor initiation threshold is crucial for improving septic shock outcomes, yet current evidence on the impact of different thresholds remains uncertain.
• What they did: A cluster-randomized, crossover trial involving 13 hospitals in Idaho and Utah compared hospital strategies initiating vasopressin at 0.1 µg/kg/min versus 0.4 µg/kg/min of norepinephrine equivalents, analyzing 3959 adult septic shock patients.
• The result: The study found no significant difference in 28-day mortality (adjusted odds ratio 0.98, P = .62) or kidney replacement therapy-free days between the lower- and higher-threshold strategies, suggesting similar effectiveness in septic shock management.