Mount Sinai Hospital Critical Care Research - Current Studies

VASST STUDY

Vasopressin Vs. Norepinephrine in Septic Shock Study

A multicentric CIHR funded study. P.I. Dr. James A. Russell

 Site Investigator:       Dr. Geeta Mehta

Site Co-ordinator:      Carlos Martinez

Ten thousand Canadians die every year from septic shock. Early mortality (<3 days) is usually from refractory hypotension. Typically pressor agents such as dopamine, norepinephrine and epinephrine are used to maintain organ perfusion pressure. However, high doses of catecholamines may actually cause, rather than improve organ ischemia and thereby perpetuate multiple organ failure.

 Vasopressin levels are decreased in human septic shock. Preliminary studies show that infusion of low dose Vasopressin (0.01-0.04 units/min) in patients who have septic shock decreases Norepinephrine dose requirements, maintains blood pressure and cardiac output, decreases pulmonary vascular resistance and increases urine output. Thus, low dose Vasopressin could improve renal and other organ function in septic shock.

 VASST is a multi-centre triple-blind randomized controlled trial and it is being conducted in several ICUs across Canada and Australia to determine the effectiveness of Vasopressin compared to Norepinephrine in increasing 28-day and 90-day survival.

 The VASST study’s primary hypothesis is that low dose Vasopressin infusion compared to Norepinephrine infusion will increase 28-day survival in human septic shock.

Patients are eligible to participate in the study if they have septic shock, at least one other sepsis related organ failure and are on vasopressor infusion(s) for ≥ 6 hours (≥5mcg/kg/min) or for ≥3 hours if in severe septic shock (≥15mcg/kg/min of vasopressor requirements).

 Patients who participate are randomized to receive either Norepinephrine or Vasopressin. Norepinephrine is started at 1.3ug/min and is titrated up to 15ug/min in 40 min. Vasopressin is started at 0.0026 units/min and is titrated up to 0.03 units/min in 40min.

Once the study drug has reached the goal rate, all open label vasopressors are weaned in a preset order according to the protocol if the patient is hemodinamically stable.

 If you require more information about our studies please do not hesitate to contact me at cmartinez@mtsinai.on.ca

 References:

1.      Patel BM, Chittock DR, Russell JA, Walley KR. Beneficial Effects of Short-term Vasopressin Infusion during Severe Septic Shock. Anaesthesiology. 2002;96:576-82

2.      Landry DW, Levin HR, Gallant EM, Ashton RC, Jr., Seo S, D’Alessandro D, Oz MC, Oliver JA. Vasopressin deficiency contributes to the vasodilation of septic shock. Circulation. 1997;95:1122-5.

3.      Malay MB, Ashton RC, Jr., Landry DW, Townsend RN. Low-dose Vasopressin in the treatment of vasodilatory septic shock. J Trauma. 1999;47:699-703; discussion 703-5.