Effect of Vasopressin Initiation Threshold on Septic Shock Mortality: The VASSPR Cluster Crossover Randomized Strategy Trial.

A hospital-level strategy of starting fixed-dose vasopressin at 0.1 µg/kg/min norepinephrine-equivalent did not reduce 28-day mortality compared with starting at 0.4 µg/kg/min in septic shock (31.8% vs 33.0%; adjusted OR 0.98, 95% CI 0.87-1.06). The trial randomized 13 hospitals in a cluster-crossover design and included 3959 patients; kidney replacement therapy-free days were also unchanged. Clinicians can defer second-line vasopressin without a mortality penalty.