PSHP 2026 Residency Conference

Evaluate the safety and efficacy of fixed dose versus titratable vasopressin infusions in critically ill patients with septic shock by comparing rebound hypotension when stopping fixed dose vs. weaning titratable vasopressin infusions. 


This retrospective cohort study reviewed patients in a medical/surgical ICU at a community hospital from October 1, 2023 to October 1, 2024 and January 1, 2025 to January 1, 2026. Adults with septic shock who received vasopressin and norepinephrine were included. Exclusion criteria included use of other catecholamines at wean, vasopressor withdrawal due to death or comfort care, mechanical circulatory support, or non-adherence to vasopressin orders. The primary endpoint was rebound hypotension defined as MAP ≤ 60 mmHg with an intervention to improve blood pressure within six hours of vasopressin discontinuation or dose reduction. Secondary endpoints included MAP changes after vasopressin discontinuation, vasopressor duration, time to vasopressor wean, time on mechanical ventilation, and ICU length of stay. Exploratory endpoints compared rebound hypotension when vasopressin or norepinephrine was discontinued first. 


A total of 78 patients were included in the analysis, with 43 in the fixed‑dose (FD) group and 35 in the titratable (TD) group. The primary outcome was met by 20 (47%) patients in the FD group and 23 (61%) patients in the TD group. There was no significant difference in rebound hypotension between groups (OR, 0.82; 95% CI, 0.45–2.01; p = 0.666). When comparing FD vs. TD vasopressin, there was no difference in rebound hypotension based on the order of vasopressor discontinuation, whether vasopressin (p = 0.524) or norepinephrine (p = 0.747) was stopped first. Patients in the TD group demonstrated significantly shorter time to vasopressor wean (p ≤ 0.001), duration of mechanical ventilation (p = 0.010), and ICU length of stay (p = 0.006). 


Overall, there was no difference in the incidence of rebound hypotension in patients who underwent abrupt discontinuation of vasopressin and those who were down-titrated off the infusion. The order of vasopressor discontinuation did not affect the likelihood of rebound hypotension. These findings suggest that titratable vasopressin strategies may support more efficient critical care management with similar hemodynamic outcomes in septic shock.