, Volume 37, Issue 9, pp 1406-1408

Arginine–vasopressin and corticosteroids in septic shock: engaged but not yet married!

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Considerable efforts have been made to spare excessive catecholamine exposure and avoid side effects when treating patients with refractory septic shock. Until recently, physiological replacement of arginine–vasopressin (AVP) and corticosteroid (CS) deficits was considered promising but equivocal to improve end-organ function [1], reduce new-onset tachyarrhythmias [2], shorten duration of shock [3], and improve survival [4]. However, two large multicenter randomized controlled trials failed to demonstrate mortality reduction when using physiological doses of AVP [5] and CS [6] and hampered the initial enthusiasm for their widespread use.

In this issue of Intensive Care Medicine, Torgersen et al. [7] evaluate the effect on mortality of adding CS to AVP in 159 patients with severe septic shock. Patients included in this single-center retrospective study were relatively ill, as outlined by high baseline sepsis-related organ failure assessment (SOFA) score (median score 15), frequent requir

This editorial refers to the article available at: doi:10.1007/s00134-011-2312-3.