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The following is a summary of “Early high-dose vasopressors in refractory septic shock: A cohort study,” published in the April 2025 issue of Journal of Critical Care by Thompson et al. 

Researchers conducted a retrospective study to examine the impact of peak vasopressor dose timing on outcomes in individuals with septic shock refractory to high-dose vasopressors.  

They analyzed adults requiring a vasopressor dose of ≥0.5 μg/kg/min norepinephrine-equivalents within the first 24 hours of septic shock. The median time to peak vasopressor dose was used to classify individuals into ‘early’ and ‘late’ groups. Multivariable Cox proportional hazards regression assessed the association between peak vasopressor timing and mortality.  

The results showed that the median time to peak vasopressor dose exposure was 6 hours (3,13), classifying individuals into early (n = 351) and late (n = 351) groups. In the severity-adjusted multivariable analysis, the early group had a lower 28-day mortality risk (HR 0.76 [95% CI 0.58–0.99]). The early group also had significantly more days alive and free from renal replacement therapy, vasopressors, and mechanical ventilation, along with a faster transition to vasopressor independence (HR 1.40 [95% CI 1.17–1.69]). Mesenteric ischemia and arrhythmias occurred more frequently in the late group.  

Investigators concluded that in vasopressor-refractory septic shock, reaching the peak vasopressor dose within the initial 6 hours of shock onset was linked to decreased mortality and an increased number of days alive and without organ support. 

Source:sciencedirect.com/science/article/abs/pii/S088394412400491X