2nd Swiss Vasopressin Consensus: Vasopressin in Septic Shock and other Vasodilatory States

Vasopressin is a non-catecholaminergic vasopressor with proven advantages in the treatment of vasodilatory states such as septic shock. Its clinical utility in this context is supported by its ability to stabilize blood pressure and tissue perfusion, reduce the norepinephrine dose and mitigate adrenergic side effects. While norepinephrine remains the first-line drug in septic shock, vasopressin serves as an adjunct therapy, typically added when norepinephrine fails to achieve the target mean arterial pressure (MAP) despite adequate fluid resuscitation. This 2^nd^ Swiss Vasopressin Consensus Report provides updated, evidence-based and practice-oriented guidance on the use of vasopressin in septic shock and selected vasodilatory states. Building upon the 1^st^ Swiss Consensus Report from 2021, this document integrates recent clinical data and expert insights and addresses practical gaps in the 2021 Surviving Sepsis Campaign (SSC) guidelines, such as vasopressin dosing, vasopressor weaning and hemodynamic monitoring. A structured treatment algorithm for the early use of vasopressin -- before the onset of catecholamine-refractory shock -- is presented. Beyond its established role in septic shock, the expert panel reviewed additional potential indications for vasopressin, including vasoplegic syndrome following cardiac surgery with cardiopulmonary bypass (CPB), acute right ventricular (RV) failure or cardiogenic shock and acute liver failure. This consensus report is intended to support anesthesiologists, intensivists and cardiovascular specialists caring for critically ill surgical and medical patients by providing clear and structured recommendations to optimize the use of vasopressin in the management of vasoplegia. PEER REVIEWED ARTICLE **Peer reviewers:** Prof. Dr med Dominique Bettex, Institute of Anesthesiology and Perioperative Medicine, University Hospital Zurich Prof. Dr med Reto Stocker, Head of Research, Teaching and Medical Quality Programmes, Hirslanden Klinik, Zurich Received on May 23, 2025; accepted after peer review on June 10, 2015; published online on June 30, 2025.