Keywords
Norepinephrine
Critically ill patient
Septic shock
Weaning
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Abstract
Objective: To provide a comprehensive description of the main clinical evidence regarding the order of discontinuation of vasopressors, specifically norepinephrine and vasopressin, in patients recovering from septic shock. Methods: This study is an Integrative Literature Review. The search for relevant studies was conducted in the LILACS and PubMed databases. The search strategy employed keywords registered in both DeCs and MeSH, using terms such as: “Septic shock,” “Vasopressin,” “Hypotension,” “Vasoconstrictor agents,” and “Norepinephrine.” Results: Among the nine articles reviewed, four studies demonstrated a higher incidence of hypotension when vasopressin was discontinued before norepinephrine in patients with septic shock. Notably, three of these studies identified this hypotension occurring within the first hour after vasopressin weaning. These findings underscore the importance of tailoring vasopressor discontinuation strategies to each patient's hemodynamic profile, with an emphasis on close and continuous monitoring. Final considerations: In critically ill patients receiving both vasopressin and norepinephrine, discontinuation of norepinephrine prior to vasopressin has been shown to result in a lower incidence of hypotension. This evidence suggests the potential for improved patient outcomes with individualized weaning strategies.
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