Is It Reasonable to Keep Using Vasopressin in Shock?

The authors of this meta-analysis seem to think so.
Unfortunately, they identify a very heterogenous set of evidence for analysis, which reduces the statistical power of every comparison.  They identify only a couple studies of vasopressin vs. placebo, and most of their studies are vasopressin vs. an increased dose of norepinephrine.
It’s hard to generate any unreasonable conclusion from this data – the error bars cross one, so you can either take this as permission to drop vasopressin from your usage patterns because its use has no measurable mortality benefit, or you can continue to use vasopressin because it doesn’t seem to be harmful, and allows you to reduce the dose of norepinephrine.
I’d really like to see more vasopressin vs. control – there’s only one reasonably sized vasopressin vs. placebo trial – and it heavily, but non-significantly, favors control with a risk ratio for mortality of 1.94 (0.74 to 5.10).
More to be done!
“Vasopressin for treatment of vasodilatory shock: an ESICM systematic review and meta-analysis”