Discontinuation order of vasopressors in the recovery phase of septic shock: A prospective observational study of endogenous norepinephrine and copeptin levels

Link of Video Abstract: https://youtu.be/dGgJsS2u5RA Introduction: The combination of norepinephrine and vasopressin is recommended to enhance the hemodynamic status in patients with septic shock. However, upon the patient's improvement, there remains a debate regarding the order for discontinuing each vasopressor. This study aimed to compare the levels of endogenous norepinephrine and copeptin (provasopressin) in septic shock patients before administration and after the withdrawal of vasopressors. Method: A prospective observational study was conducted to analyze the levels of endogenous norepinephrine and copeptin as provasopressin in patients with septic shock, both before the administration of vasopressors and after their discontinuation. We conducted the research in the ICU of Wahidin Sudirohusodo Hospital Makassar and Kanudjoso Djatiwibowo Hospital Balikpapan, Indonesia from February to July 2024. Endogenous Norepinephrine and Copeptin levels were then analyzed at Hasanuddin University Medical Research Center, Makassar, Indonesia. Results: Norepinephrine and copeptin increased in patients with improved septic shock. Conversely, in patients who experienced a return to shock state after discontinuing vasopressors, there was a significant decrease in copeptin levels (p = 0.048). Conclusion: Low plasma levels of copeptin have been associated with an increased risk of recurrent shock, suggesting that the consideration of maintaining vasopressin following the discontinuation of exogenous catecholamines.