{"id":1035,"date":"2025-07-05T06:00:39","date_gmt":"2025-07-05T06:00:39","guid":{"rendered":"https:\/\/perfusfind.com\/ic\/?p=1035"},"modified":"2025-07-05T02:20:07","modified_gmt":"2025-07-05T02:20:07","slug":"vasopressin-use-across-shock-states-international-insights-from-an-international-esicm-endorsed-survey-the-press-survey","status":"publish","type":"post","link":"https:\/\/perfusfind.com\/ic\/index.php\/2025\/07\/05\/vasopressin-use-across-shock-states-international-insights-from-an-international-esicm-endorsed-survey-the-press-survey\/","title":{"rendered":"Vasopressin use across shock states: international insights from an international ESICM-endorsed survey: the PRESS Survey"},"content":{"rendered":"
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Summary <\/strong><\/p>\n<\/blockquote>\n

This international survey, endorsed by the European Society of Intensive Care Medicine (ESICM), assessed the current clinical use of vasopressin and terlipressin in patients with septic shock. The survey included 1,919 intensivists from 124 countries, highlighting significant variability in vasopressin availability, clinical indications, dosing strategies, and discontinuation practices. Results underscore the heterogeneity of current practices, suggesting an urgent need for clearer clinical guidelines and more personalized vasopressin use strategies in septic shock management.<\/p>\n

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World map showing the number of respondents per country. The intensity of the blue color indicates the number of respondents per country: the lightest blue color indicates countries with the lowest number of respondents (Luxembourg, Ukraine, Latvia, Cyprus, Mali, Ghana, Somalia, Democratic Republic of Congo, Bolivia, El Salvador, Guatemala, Cambodia, Thailand, Armenia, Uzbekistan, China, Lebanon, Oman, Belize and Samoa, n\u2009=\u20091) and the darkest blue color indicates the country with the highest number of respondents (India, n\u2009=\u2009163)<\/figcaption><\/figure>\n
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Key Points<\/strong><\/p>\n

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  1. \n

    Survey Background and Rationale<\/strong>: Septic shock remains associated with significant morbidity and mortality, prompting international guidelines to recommend vasopressin as a second-line vasopressor. However, substantial uncertainty and variability in vasopressin use persist internationally.<\/p>\n<\/li>\n

  2. \n

    Global Survey Participation<\/strong>: The survey received responses from 1,919 intensivists across 124 countries, predominantly from high and upper-middle income regions, providing broad international insights into vasopressin practices.<\/p>\n<\/li>\n

  3. \n

    Clinical Indications for Vasopressin<\/strong>: Major indications reported included refractory septic shock (73% of respondents), catecholamine sparing in refractory shock (53%), refractory vasoplegic shock without left ventricular dysfunction (51%), and septic shock characterized by high cardiac output and low systemic vascular resistance (49%).<\/p>\n<\/li>\n

  4. \n

    Contraindications and Risks<\/strong>: Common contraindications included non-occlusive mesenteric ischemia and digital or skin ischemia, with the most feared adverse effects being mesenteric ischemia, digital or skin ischemia, and cardiac ischemia.<\/p>\n<\/li>\n

  5. \n

    Timing of Vasopressin Initiation<\/strong>: Vasopressin or terlipressin were predominantly initiated after initial fluid resuscitation and norepinephrine administration (93%), with initiation primarily triggered by doses of norepinephrine base between 0.25-0.50 \u00b5g\/kg\/min, typically after 2-6 hours of norepinephrine administration.<\/p>\n<\/li>\n

  6. \n

    Dosage and Administration<\/strong>: Most respondents initiated vasopressin at fixed initial doses (0.01\u20130.03 U\/min), commonly adjusting doses according to mean arterial pressure. Significant heterogeneity existed regarding initial dosing, titration approaches, and maximum dosages used.<\/p>\n<\/li>\n

  7. \n

    Discontinuation Strategies<\/strong>: Discontinuation practices were varied, primarily guided by mean arterial pressure levels and reductions in norepinephrine dosage. Most respondents tapered vasopressin progressively once first-line vasopressor doses dropped below a predefined threshold.<\/p>\n<\/li>\n

  8. \n

    Use of Corticosteroids<\/strong>: Corticosteroids were administered by 66% of respondents prior to considering second-line vasopressors, indicating variability in adherence to international guidelines recommending their use.<\/p>\n<\/li>\n

  9. \n

    Role of Echocardiography<\/strong>: Echocardiography was the predominant hemodynamic monitoring tool employed (84%), reflecting broad acceptance of echocardiographic evaluation in critical care settings.<\/p>\n<\/li>\n

  10. \n

    Practice Variability and Need for Guidance<\/strong>: Despite widespread use, significant variations exist globally regarding vasopressin handling. This variability highlights the need for clear and personalized clinical guidelines to optimize treatment outcomes.<\/p>\n<\/li>\n<\/ol>\n

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    Clinical and biological triggers for vasopressin or terlipressin initiation. Clinical and biological triggers for vasopressin or terlipressin initiation in respondents working in high and upper-middle income level countries (outer ring) and lower-middle and low-income level countries (inner ring). The proportion of respondents who report using the trigger is indicated for each trigger. SVR: systemic vascular resistance, PCO2: partial pressure of carbon dioxide<\/figcaption><\/figure>\n
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    Conclusion<\/strong><\/p>\n

    This extensive international survey highlights substantial heterogeneity in the clinical use of vasopressin and terlipressin among intensivists managing septic shock, particularly concerning initiation triggers, dosing strategies, and discontinuation practices. It emphasizes the critical need for standardized guidelines and personalized approaches to improve clinical practice and patient outcomes.<\/p>\n

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    Dose of norepinephrine base and duration of norepinephrine administration considered as triggers for vasopressin or terlipressin initiation. Panel A<\/em>: dose of norepinephrine base considered to be a trigger for vasopressin or terlipressin initiation in all respondents using them in patients with septic shock. Each bar shows the distribution (in percent) of respondents for each norepinephrine dose range. Panel B<\/em>: duration of norepinephrine administration considered to be a trigger for vasopressin or terlipressin initiation in all respondents using them in patients with septic shock. Each bar shows the distribution (in percent) of respondents for each range of duration of norepinephrine administration. Panel C<\/em>: combination of the dose of norepinephrine base and duration of administration considered to be a trigger for vasopressin or terlipressin initiation in all respondents using them in patients with septic shock. Each bar shows the distribution (in percent) of respondents for each combination range<\/figcaption><\/figure>\n

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    Open Access<\/strong> This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:\/\/creativecommons.org\/licenses\/by\/4.0\/<\/strong><\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

    Summary This international survey, endorsed by the European Society of Intensive Care Medicine (ESICM), assessed the current clinical use of vasopressin and terlipressin in patients with septic shock. The survey included 1,919 intensivists from 124 countries, highlighting significant variability in vasopressin availability, clinical indications, dosing strategies, and discontinuation practices. Results underscore the heterogeneity of current […]<\/p>\n","protected":false},"author":1,"featured_media":1036,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[66],"tags":[119,471],"class_list":["post-1035","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-pharmacological-insights-in-critical-care","tag-shock","tag-vasopressin"],"yoast_head":"\nVasopressin use across shock states: international insights from an international ESICM-endorsed survey: the PRESS Survey - Perfusfind Intensive Care<\/title>\n<meta name=\"description\" content=\"Vasopressin is currently suggested as a second-line vasopressor in patients with septic shock and persistent arterial hypotension. 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The survey included 1,919 intensivists from 124 countries, highlighting significant variability in vasopressin availability, clinical indications, dosing strategies, and discontinuation practices. Results underscore the heterogeneity of current…","_links":{"self":[{"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/posts\/1035","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/comments?post=1035"}],"version-history":[{"count":1,"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/posts\/1035\/revisions"}],"predecessor-version":[{"id":1037,"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/posts\/1035\/revisions\/1037"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/media\/1036"}],"wp:attachment":[{"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/media?parent=1035"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/categories?post=1035"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/tags?post=1035"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}