Vasopressin use across shock states: international insights from an international ESICM-endorsed survey: the PRESS Survey
Abstract
Background: Vasopressin is currently suggested as a second-line vasopressor in patients with septic shock and persistent arterial hypotension. This survey aimed to assess the current use of vasopressin and terlipressin in patients with septic shock.
Methods: An international survey endorsed by the European Society of the Intensive Care Medicine. All items addressed the different areas of uncertainty and research identified from current international recommendations. RESULTS: 1919 intensivists from 124 countries responded to the survey: 1220(64%) worked in Europe, 1430(74%) in high and upper-middle income level countries and 916(48%) in academic ICUs. Vasopressin or terlipressin were available to 1830(95%) respondents. The main reported indications were refractory septic shock, catecholamine sparing in all types of refractory shock, refractory vasoplegic shock (other than septic) without reduced left ventricular systolic function and septic shock with high cardiac output and low systemic vascular resistance (73%,53%,51% and 49% of respondents, respectively). The main reported contraindications were non-occlusive mesenteric ischemia and digital or skin ischemia. Overall, 1506(78%) respondents used vasopressin or terlipressin, 93% of them as a second-line vasopressor after initial resuscitation, mainly to increase blood pressure and reduce the catecholamine load. The dose of norepinephrine alone or the duration of norepinephrine administration alone triggered vasopressin and…
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