Trial reportCritical care (London, England)2018
Incidence of hypotension according to the discontinuation order of vasopressors in the management of septic shock: a prospective randomized trial (DOVSS).
Trial report in Critical care (London, England), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 16 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Incidence of Hypotension Based on the Discontinuation Order of Vasopressors in the Management of Septic Shock
Incidence of Hypotension in the Weaning From Vasopressor Drugs
Weaning Approaches for Vasopressin in Sepsis - a Randomized Controlled Trial of Titrated Versus Abrupt Discontinuation During Stabilization of Septic Shock - WAVES Trial
Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 48 citations in OpenAlex.
- Incidence of Hypotension after Discontinuation of Norepinephrine or Arginine Vasopressin in Patients with Septic Shock: a Systematic Review and Meta-Analysis.Journal of Korean medical science · 2020Pooled it
- Vasopressor weaning in septic shock: the missing piece in the 2026 guidelines.Intensive care medicine · 2026Article
- Vasopressin in cardiogenic shock: pathophysiology, clinical evidence, and therapeutic perspectives.ESC heart failure · 2026Article
- Vasopressin use across shock states: international insights from an international ESICM-endorsed survey: the PRESS Survey.Critical care (London, England) · 2025Article
- Hemodynamic effects of adjunct arginine vasopressin to norepinephrine in septic shock: insights from a prospective multicenter registry study.Annals of intensive care · 2025Article
- Comparison of short-term and long-term renal function effects of vasopressin and norepinephrine in patients with septic shock: a systematic review and meta-analysis.Frontiers in pharmacology · 2025Review
- The Eight Unanswered and Answered Questions about the Use of Vasopressors in Septic Shock.Journal of clinical medicine · 2023Review
- Clinical Controversy Over Vasopressin in Septic Shock: A Survey of Critical Care Pharmacists.Hospital pharmacy · 2021Article
- Vasopressor-Sparing Strategies in Patients with Shock: A Scoping-Review and an Evidence-Based Strategy Proposition.Journal of clinical medicine · 2021Article
- Vasopressor therapy in critically ill patients with shock.Intensive care medicine · 2019Review
- Perceptions regarding vasopressin use and practices in septic shock, and cost containment strategies.Journal of the American College of Clinical Pharmacy : JACCP · 2019Article
- Response to "Incidence of hypotension according to the discontinuation order of vasopressors: a matter of pharmacokinetics".Critical care (London, England) · 2019Article
- Weaning order of vasoactive drugs.Critical care (London, England) · 2019Article
- Incidence of hypotension according to the discontinuation order of vasopressors: a matter of pharmacokinetics.Critical care (London, England) · 2019Article
- Response to "Weaning order of vasoactive drugs".Critical care (London, England) · 2019Article
- Vasopressor weaning in sepsis: Debate is being continued!Journal of anaesthesiology, clinical pharmacologyArticle
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundVasopressin (AVP) is commonly added to norepinephrine (NE) to reverse shock in patients with sepsis. However, there are no data to support the appropriate strategy of vasopressor tapering in patients on concomitant NE and AVP who are recovering from septic shock. Therefore, the objective of this study was to evaluate the incidence of hypotension while tapering vasopressors in patients on concomitant NE and AVP recovering from septic shock.
methodsPatients with septic shock receiving concomitant NE and AVP were randomly assigned to taper NE first (NE group) or AVP first (AVP group). The primary end point was the incidence of hypotension within one hour of tapering of the first vasopressor. We also evaluated the association between serum copeptin levels and the occurrence of hypotension.
resultsThe study was stopped early due to a significant difference in the incidence of hypotension after 38 and 40 patients were enrolled in the NE group and the AVP group, respectively. There were 26 patients (68.4%) in the NE group versus 9 patients (22.5%) in the AVP group who developed hypotension after tapering the first vasopressor (p < 0.001). There was a similar finding during the subsequent tapering of the second vasopressor (64.5% in the NE vs 25.0% in the AVP group, p = 0.020). Finally, NE tapering was significantly associated with hypotension during the study period (hazard ratio, 2.221; 95% confidence interval, 1.106-4.460; p = 0.025). The serum copeptin level was lower in patients in whom hypotension developed during tapering of AVP than it was in those without hypotension.
conclusionsTapering NE rather than AVP may be associated with a higher incidence of hypotension in patients recovering from septic shock who are on concomitant NE and AVP. However, further studies with larger sample sizes are required to better determine the appropriate strategy for vasopressor tapering.
trial registrationClinicalTrials.gov, NCT01493102 . Registered on 15 December 2011.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.