ArticleCritical care (London, England)2025
Effect of early adjunctive vasopressin initiation for septic shock patients: a target trial emulation.
Article in Critical care (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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Who cites it
18 citing papers in PubMed.
- Clinical trials testing early multimodal vasopressor therapy require a dose ceiling, not a dose floor.Critical care (London, England) · 2026Article
- Ultra-early versus early adjunctive vasopressin initiation after norepinephrine escalation in septic shock: a target trial emulation.Intensive care medicine · 2026Article
- A pilot study of the effect of norepinephrine dose on left ventricular-arterial coupling in patients with septic shock.Scientific reports · 2026Article
- Mastering the practical application of vasopressin at the bedside in septic shock.Intensive care medicine · 2026Article
- Epidemiology and pharmacological management of new onset atrial fibrillation in critically ill adults: A multicentre observational study.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2026Article
- When should we start vasopressin in septic shock? Revisiting an old question.Journal of intensive medicine · 2026Article
- Impact of Early versus Delayed Vasopressin Initiation on 28-Day Mortality in Older Adults with Septic Shock.Therapeutics and clinical risk management · 2026Article
- Localized surface plasmon resonance-based point-of-care testing for pediatric sepsis.Frontiers in pediatrics · 2026Review
- Severity-stratified vasopressor-escalation strategies in septic shock: a cross-fitted doubly robust analysis with external replication.Frontiers in pharmacology · 2026Article
- Current standard of care for septic shock.Intensive care medicine · 2026Review
- Management of post-resuscitation vasoplegic shock: targets, strategies and outcomes.Critical care (London, England) · 2025Review
- Review
- Author Response: Timing Matters: Caution and Opportunity in Early Vasopressin for Septic Shock.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2025Article
- Opportunities, challenges and future perspectives for target trial emulation in critical care clinical research.Critical care (London, England) · 2025Review
- It's Time to Consider How We Should Use Vasopressors, Rather Than Just Which We Should Use.Critical care explorations · 2025Article
- Vasopressin and its analogues in patients with septic shock: holy Grail or unfulfilled promise?Critical care (London, England) · 2025Review
- Vasopressin use across shock states: international insights from an international ESICM-endorsed survey: the PRESS Survey.Critical care (London, England) · 2025Article
- Opinion on "Artificial intelligence in sepsis early prediction and diagnosis using unstructured data in healthcare".Frontiers in immunology · 2025Article
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Authors and funding
19 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn septic shock, the optimal timing of adjunctive vasopressin initiation shock is unknown. We aimed to assess the effect of its early initiation for patients with septic shock.
methodsWe conducted a multicenter target trial emulation to estimate the intensive care unit (ICU) mortality effect of early (≤ 6 h) adjunctive vasopressin compared with usual care. Eligible patients had septic shock diagnosed within 6 h of ICU admission. The primary outcome of this study was 30-day ICU mortality. Subgroup analyses were conducted to test the interaction of early vasopressin start with peak norepinephrine-equivalent dose (NED) at 6 h, APACHE score, peak lactate at 6 h and invasive mechanical ventilation. Secondary outcomes were the impact of delayed vasopressin introduction on 30-day ICU mortality and effect of NED at vasopressin start on 30-day ICU mortality. We used the parametric g-formula to emulate a target trial.
resultsOverall, 3,105 patients fulfilled the inclusion criteria. Mean age was 62 years and mean APACHE III score was 83. In the first six hours of vasopressor therapy, 1,864 (60%) patients were invasively ventilated. Estimated 30-day ICU mortality was 19.34% (95%CI, 17.0 to 21.68) in the no vasopressin group and 18.45% (95%CI, 16.26 to 20.63) in the early vasopressin group; relative risk 0.95 (95%CI, 0.93 to 0.98). The estimated 30-day ICU mortality effect of starting vasopressin was particularly strong at lower norepinephrine doses (< 0.25 µg.kg
conclusionsIn this emulation of a hypothetical target trial, patients with septic shock benefited from early vasopressin administration. These findings can help design prospective randomised-control trials of early adjunctive vasopressin use in septic shock.
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