S01E24: VASST Revisited — Vasopressin, Norepinephrine, and the Timing Question in Septic Shock

In this episode of PRISM Rounds, we revisit the landmark New England Journal of Medicine trial “Vasopressin versus Norepinephrine Infusion in Patients with Septic Shock” from February 28, 2008, along with the accompanying Parrillo editorial. We break down what the VASST trial actually showed, why the overall mortality result was negative, and why the “less severe shock” subgroup still shaped bedside practice for years.Along the way, we discuss why septic shock often does not trigger the same urgency as myocardial infarction, what this trial taught us about vasopressin as an adjunct rather than a rescue pressor, and whether low-dose vasopressin truly increased ischemic complications. This is a practical, teaching-rounds style review for fellows, residents, ICU clinicians, and anyone who wants a clearer bedside translation of one of the classic septic shock papers.PubMed linksVASST trial: https://pubmed.ncbi.nlm.nih.gov/18305265/ Editorial: https://pubmed.ncbi.nlm.nih.gov/18305266/ Tags#CriticalCare #ICU #SepticShock #Sepsis #Vasopressin #Norepinephrine #Pressors #Vasopressor #NEJM #MedicalEducation #FOAMed #PulmCrit #EMCrit #InternalMedicine #PCCM #ResidentEducation #FellowEducation #JournalClub #EvidenceBasedMedicine #PRISMRounds