ArticleCritical care (London, England)2026
Attenuated hemodynamic response to adjunct vasopressin in obese septic shock patients: a physiological or dose-dependent effect?
Article in Critical care (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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.
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Who cites it
5 citing papers in PubMed.
- Vasopressor-Associated Limb Ischemia Resulting in Quadruple Amputation in Suspected Septic Shock.Clinical case reports · 2026Article
- BMI-dependent norepinephrine trajectories during vasopressin therapy in septic shock persist independent of weight-normalization and body composition.Critical care (London, England) · 2026Article
- Weight-normalized norepinephrine dosing and apparent BMI-dependent vasopressin responsiveness.Critical care (London, England) · 2026Article
- Absolute, weight-based, fixed-dose, or phenotype-guided? Rethinking the meaning of vasopressor dose in critical care.Annals of intensive care · 2026Article
- High blood pressure-targeted management associated with reduced benefits of higher body mass index in elderly patients with septic shock: a post hoc analysis of a multicenter randomized controlled trial.Annals of intensive care · 2026Article
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionObesity is increasingly prevalent in ICU patients, often requiring adjusted dosing due to altered drug pharmacodynamics. Arginine vasopressin (AVP) is used adjunctively to norepinephrine (NE) in septic shock, but its hemodynamic efficacy may vary with body mass index (BMI), potentially influencing NE-sparing effects.
methodsA post-hoc analysis of 200 adults with septic shock from a multicenter registry. Patients were grouped into normal weight (BMI<25 kg/m
resultsThirty-three percent were normal weight, 34.5% overweight and 32.5% obese. The model-estimated NE dose decreased by 6.1% (95%CI 1.7-10.6) per hour in normal weight patients, remained stable in overweight patients (-2.0%, 95%CI -6.3-2.4), and increased by 5.5% (95%CI 1.0-10.0) per hour in obese patients. The three-way interaction of AVP dose, time and BMI was significant (p<0.001), with higher AVP dose being associated with a decrease in NE requirements in normal weight patients but not in overweight and obese patients. BMI-adjusted AVP dosing did not significantly alter NE requirements compared to fixed dose (all p>0.70).
conclusionsIn septic shock patients, obesity is associated with increased NE requirement after AVP initiation, in contrast to the reduction observed in normal weight patients. Obesity-related resistance to AVP may be driven by intrinsic physiological factors rather than insufficient dosing.
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