Preliminary results of synergy between norepinephrine and terlipressin during septic shock
We congratulate Dr. Liu and colleagues for their impressive randomized clinical trial (RCT). The authors compared terlipressin and norepinephrine as first-line vasopressor in septic shock . They reported a similar result in both groups. In an insightful editorial, Drs. Mårtensson and Gordon questioned the benefit of simultaneously using the two drugs, instead of monotherapy .
In a previous observational study, we showed that a dose of norepinephrine above 1 µg/kg/min was associated with a mortality rate above 90% . As a result of this finding, we introduced terlipressin in our local protocol as standard of care in septic shock patients receiving norepinephrine above 0.5 µg/kg/min. Of note, the patients with a central venous oxygen saturation (ScvO2) below 70%, reflecting an inappropriate cardiac output, were excluded. Terlipressin was administered as an initial bolus (0.25 mg over 30 min) followed by a fixed continuous infusion (0.01 µg/kg/min), in addition to...
Compliance with ethical standards
Conflicts of interest
ML discloses conflicts of interest with Aguettant, Amomed, MSD, Octapharma Pfizer (Lectures). GD, MC, SM, and NR do not disclose any conflict of interest. GD assumes responsibility for the data.
The study received the approval of our ethics committee (IRB 00010254–2018–147).
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