Arginine Vasopressin in Vasodilatory Shock

Abstract

To the Editor: Dunser et al1 concluded that the combined infusion of vasopressin and norepinephrine is superior to infusion of norepinephrine alone in the treatment of shock resistant to catecholamine. We believe that this study is flawed and do not support such a conclusion. First of all, the design included two interventions in parallel, one of arginine vasopressin (and its control group in the other arm, without such treatment) and the other with two different doses of norepinephrine. They concluded that the combination group required a lower dose of norepinephrine, which was a consequence of the experimental protocol. The major shortcoming of this study, however, is an evident mistake in the statistical interpretation of their main results. The authors concluded that patients treated with the combination had improved cardiac performance, an effect that did not occur at all. Table 2 of …