In this meta-analysis, the addition of vasopressin to catecholamine vasopressors compared with catecholamines alone was associated with a lower risk of atrial fibrillation. However, findings for secondary outcomes varied. This study has several limitations. First, subgroup analyses were restricted by the study-level nature of the data. Second, the quality of reporting for many studies was not sufficient to permit definitive judgments about risk of bias in all domains. Third, there are likely differences in the way vasopressors were initiated, titrated, and weaned between studies and approaches were infrequently described in detail. However, the general approach seemed to be to up-titrate vasopressin until the maximum dose or target mean arterial pressure (MAP) was reached and then to add or wean norepinephrine as needed to reach the target MAP. This review included data from the relatively large and recently published Vasopressin vs Norepinephrine in Patients with Vasoplegic Shock after Cardiac Surgery (VANCS) and Effect of Early Vasopressin vs Norepinephrine on Kidney Failure in Patients With Septic Shock (VANISH) trials (751 patients total)

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