SSC Guideline Recommendation: The Surviving Sepsis Campaign (SSC) weakly recommends adding vasopressin as a second-line agent instead of continuously escalating norepinephrine if a patient’s mean arterial pressure (MAP) remains inadequate.

Trigger for Initiation: Committee experts suggest initiating vasopressin when norepinephrine doses reach between 0.25 to 0.5 ug/kg/min.

Physiological Rationale: While vasopressin levels are initially elevated in shock, a relative vasopressin deficiency often accompanies the severe vasodilation (vasoplegia) seen in septic shock, making its replacement therapy effective.

Standard Dose: The typical fixed dose of vasopressin used in septic shock is $0.03$ international units (IU)/min.

Evidence Gaps: The optimal timing for starting vasopressin therapy remains a subject of ongoing debate.

There is a lack of systematic evaluation regarding its administration via peripheral intravenous (IV) access, although this route was previously standard for treating portal hypertension.

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