Did the beneficial renal outcomes with vasopressin VANISH?

Sepsis is the most common cause of infection-related death and is increasing in incidence. This disease state has a high mortality rate and is costly, with annual costs in the United States exceeding $24 billion (1). Therefore, optimal treatment of patients with septic shock is paramount. After aggressive fluid resuscitation, vasoactive agents are the mainstay of therapy to ensure adequate end organ perfusion. However, there are limited data regarding the optimal approach to the utilization of these agents beyond initial therapy. The 2012 Surviving Sepsis Campaign Guidelines (2) recommend norepinephrine (NE) as the first line vasoactive agent and epinephrine, vasopressin (AVP), or, in some circumstances, phenylephrine, as second line agents. However, data are not robust to guide the practitioner to the most appropriate second vasoactive agent to utilize and more information comparing outcomes between agents is needed.