Administration of vasopressin in septic shock

Despite advances in medical science, sepsis remains a relevant, complex disease with significant mortality in the setting of septic shock. A feature of septic shock is haemodynamic instability characterised by vasodilatation, hypotension and inadequate tissue perfusion. Conventional care using fluid resuscitation and catecholamine vasopressors is often unable to restore adequate perfusion and improve outcome. Consequently, there is an increasing interest in exploring alternative vasoactive agents. One such agent is vasopressin, which has shown promise as an adjunct in the treatment of septic shock. In septic shock, clinical trials studying the efficacy and safety of vasopressin have produced mixed results, prompting ongoing debate and further investigation. There is still no unanimous consensus on its use. A number of randomised controlled trials have evaluated the use of vasopressin as an adjunct to conventional therapy and have demonstrated potential benefits such as improved haemodynamic stability and improved mortality in patients with milder septic conditions. However, the conflicting results and concerns about adverse events, including ischaemic complications, require a comprehensive understanding of optimal dosing, timing and appropriate patient selection. The aim of our summary review is to provide a comprehensive overview of vasopressin and its use in the treatment of septic shock. It summarises current findings from clinical trials that vasopressin therapy is a cost-effective adjunctive vasopressor to noradrenaline therapy. It is effective in reducing patients' need for catecholamines, may reduce the need for renal replacement therapy and the incidence of new arrhythmias, but is currently recommended as a second -line agent in the absence of strong evidence, due to often conflicting or unreliable trial results.