(1654) Vasopressor Discontinuation Strategies in Hemorrhagic Shock

Introduction: In septic shock, several retrospective studies have shown decreased rates of rebound hypotension when norepinephrine (NE) is discontinued before vasopressin (VP). At this time, there are no studies assessing vasopressor discontinuation order in patients with hemorrhagic shock. This project aims to compare rates of rebound hypotension and clinical outcomes based on the order of NE and VP discontinuation in patients with hemorrhagic shock.

Methods: A retrospective chart review of adult, Trauma ICU patients with hemorrhagic shock and treated with concomitant NE and VP between 2018 and 2022 was performed. Patients were included if they were 18 – 89 years old, received continuous NE and VP infusions for ≥ 6 hours, received blood products, and had documented ICD 9 or 10 codes indicating hemorrhagic shock and systolic pressures < 90 mmHg. The primary outcome was the incidence of rebound hypotension within 6 hours of initial vasopressor discontinuation based on the order of discontinuation of NE and VP. Secondary outcomes include the comparison of clinical outcomes based on the order of vasopressor discontinuation.

Results: Of the 17 patients included for analysis, 10 had norepinephrine discontinued first (NE1) and 7 had vasopressin discontinued first (VP1). There was no significant difference in baseline characteristics between the groups. The primary outcome of rebound hypotension occurred in six (60%) NE1 patients and five (71.4%) VP1 patients (relative risk [RR], 0.840; P = 0.627). As for secondary outcomes, there was no difference between the groups regarding ICU and hospital length of stay and ICU and hospital mortality.

Conclusions: In patients with hemorrhagic shock, this study found no difference in the incidence of rebound hypotension, ICU or hospital mortality, or length of stay regarding the order of discontinuation of NE and VP. However, prospective studies with larger sample sizes are warranted to further investigate the effect of vasopressor discontinuation strategies in patients with hemorrhagic shock.