Incidence of Hypotension Associated With Two Different Vasopressin Discontinuation Strategies in the Recovery Phase of Septic Shock

Author:

Murata Joseph1ORCID,Buckley Mitchell1ORCID,Lehn Julie1,Agarwal Sumit K.2,Stevenson Byron3,Martinez Brandon1,MacLaren Robert4ORCID

Affiliation:

1. Department of Pharmacy, Banner – University Medical Center Phoenix, Phoenix, AZ, USA

2. Department of Care Transformation, Banner – University Medical Center Phoenix, Phoenix, AZ, USA

3. Pharmacy Practice Resident, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA

4. Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA

Abstract

Introduction Safe and effective vasopressor withdrawal strategies during the recovery phase of septic shock lack consensus and are not addressed in clinical practice guidelines. The purpose of this study was to compare the incidence of clinically relevant hypotension associated with different vasopressin (AVP) discontinuation strategies. Methods This was a single-center, retrospective, cohort study, conducted at a university medical center over a three-year period. Adult patients ≥18 years with septic shock were included in the study. Patients were stratified into two groups; patients incrementally weaned from AVP and patients in which AVP was abruptly discontinued. The primary endpoint was to compare the incidence of clinically relevant hypotension between study groups up to 24 hours following discontinuation. Secondary analyses included the incidence of any hypotensive event up to 24 hours after AVP cessation, intensive care unit and hospital length of stay, and in-hospital mortality. Results A total of 74 patients (n = 46 AVP wean and n = 28 AVP no-wean) met inclusion criteria and were included in the study. The primary outcome was not statistically different between groups. Clinically relevant hypotension occurred in 24 patients (52.3%) and 16 patients (57.1%) in the AVP wean and AVP no-wean groups, respectively (P = .68). There were no significant differences in any secondary clinical outcome between the two study groups. Conclusion No differences were found in the incidence of clinically relevant hypotension, length of stay, or mortality between AVP weaning and no-weaning discontinuation strategies. These findings suggest incremental weaning and abrupt withdrawal of AVP are both acceptable discontinuation strategies.

Publisher

SAGE Publications

Subject

Pharmacology (medical)

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1. Surviving Sepsis Campaign Research Priorities 2023;Critical Care Medicine;2024-01-19

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