Combination of Norepinephrine with Phenylephrine Versus Norepinephrine with Vasopressin in Critically Ill Patients with Septic Shock: A Retrospective Study

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 norepineph-rine with phenylephrine to those treated with norepinephrine with vasopressin. Multivariate analysis was car-ried 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 phenyl-ephrine 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% con-fidence interval 0.31, 1.23, p = 0.17).Conclusion: Phenylephrine used as a second-line vasoactive agent combined with norepinephrine may be a rea-sonable option compared to vasopressin. However, this finding needs to be validated in a randomized controlled trial.(c) 2022 Published by Elsevier Inc.