Combination of norepinephrine with phenylephrine versus norepinephrine with vasopressin in critically ill patients with septic shock: A retrospective study

Abstract

Purpose: To evaluate the outcomes of patients with septic shock treated with a combination of norepinephrine with phenylephrine compared to norepinephrine with vasopressin. Materials and methods: This was a retrospective cohort study including adults admitted between 2002 and 2017 with septic shock according to the Sepsis 3 criteria. We compared outcomes of patients treated with norepinephrine with phenylephrine to those treated with norepinephrine with vasopressin. Multivariate analysis was carried out to evaluate the association of norepinephrine with phenylephrine compared to norepinephrine with vasopressin with in-hospital mortality. Results: During the study period, 158 patients with septic shock were treated with norepinephrine with phenylephrine and 129 with norepinephrine with vasopressin. Crude in-hospital mortality was not different between the two groups [91/158 (57.6%) versus 80/129 (62.5%), p = 0.40]. There was also no difference in ICU length of stay or hospital length of stay. Multivariate analysis demonstrated no significant association of norepinephrine with phenylephrine with in-hospital mortality compared to norepinephrine with vasopressin (OR 0.62 (95% confidence interval 0.31, 1.23, p = 0.17). Conclusion: Phenylephrine used as a second-line vasoactive agent combined with norepinephrine may be a reasonable option compared to vasopressin. However, this finding needs to be validated in a randomized controlled trial.