A 55-year-old man in septic shock post-abdominal surgery has a MAP of 55 mmHg despite 3 L crystalloid. He is on noradrenaline 0.3 mcg/kg/min. His vasopressin level is expected to be low (vasopressin-deficient phase). According to the VANISH trial, adding vasopressin to noradrenaline in septic shock has which primary benefit?

• A Significant reduction in 28-day mortality
• B Improved cardiac output and stroke volume index
• C Reduction in intra-abdominal hypertension
• D Reduction in noradrenaline requirements and renal replacement therapy use ✓

Explanation

The VANISH trial (Gordon et al., JAMA 2016) compared vasopressin + hydrocortisone/placebo vs noradrenaline + hydrocortisone/placebo in septic shock. Vasopressin reduced noradrenaline requirements and significantly decreased the need for renal replacement therapy in patients with septic shock. There was no significant reduction in 28-day mortality. The benefit is primarily 'catecholamine-sparing' and renal-protective. Vasopressin acts on V1 receptors causing vasoconstriction without increasing heart rate.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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