Comparison of Epinephrine and Vasopressin as Second line Vasopressor in Patients with Septic Shock

Abstract

Introduction: Septic shock continues to be a significant contributor of ICU mortality. Norepinephrine stands as the primary choice for vasopressor therapy. Either epinephrine or vasopressin is added to norepinephrine or vasopressin to attain the desired mean arterial pressure target. Head-to-head comparisons of these second-line options are scarce. We aimed to compare the effect of epinephrine and vasopressin on 7-day and 28-day mortality, occurrence of acute kidney injury, the duration of mechanical ventilation, as well as the lengths of stay in the ICU and hospital among patients diagnosed with septic shock.

Methodology: Our study included 22 adult patients diagnosed with septic shock who were admitted to the intensive care unit (ICU). When the dose of norepinephrine reached 15 mcg/min, either epinephrine (Group E) or vasopressin (Group V) was added according to the discretion of attending intensivist. Patients were followed-up for a period extending up to 28 days following the initiation of these vasopressors.

Results: In this study of septic shock patients in ICU, epinephrine (n=7) vs. vasopressin (n=15) showed similar 7-day mortality (57% vs. 67%, p=1) and 28-day mortality (0% vs. 7%, p=0.6). While Acute Kidney Injury rates were comparable (71% vs. 47%, p=0.38), epinephrine significantly shortened ventilation (2.8 vs. 5.2 days, p=0.04) and ICU stay (3.2 vs. 5.6 days, p=0.03). Duration of hospital stay remained similar (4.5 vs. 6.4 days, p=0.17).

Conclusion: Administration of either epinephrine or vasopressin as a second line vasopressor has similar effect on 7 and 28-day mortality, incidence of acute kidney injury and the overall duration of hospital stay. Nevertheless, individuals administered with epinephrine experienced a reduced duration of mechanical ventilation and shorter ICU length of stay.