Utilization Patterns and Outcome Impact of Inotrope–vasopressin Combinations Across Different Shock Phenotypes (Septic, Cardiogenic, Hypovolemic) in a Resource-limited Tertiary Care Setting: A Six-month Prospective Observational Analysis

Abstract

Background: Shock represents a life-threatening state of circulatory failure characterized by inadequate tissue perfusion and impaired oxygen delivery. Vasoactive agents including inotropes and vasopressors remain central to hemodynamic stabilization. Although norepinephrine is widely recommended as first-line therapy, vasopressin is frequently added in refractory hypotension. Evidence regarding real-world utilization patterns and outcome impact across different shock phenotypes in resource-limited tertiary care settings remains limited.
Objective: To evaluate prescribing patterns and clinical outcomes associated with inotropes and vasopressin therapy in septic, cardiogenic, and hypovolemic shock patients admitted to an intensive care unit.
Methods: A prospective observational study was conducted over six months in the medicine intensive care unit of a tertiary care teaching hospital. All adult patients diagnosed with shock and receiving vasopressor/inotrope therapy were included. Demographic characteristics, type of shock, vasoactive drug utilization, combination therapy, and clinical outcomes (mortality and survival) were recorded and analyzed descriptively.
Results: A total of 106 patients were included. Septic shock was the most common phenotype (65%), followed by cardiogenic (22%) and hypovolemic shock (13%).Norepinephrine monotherapy was the most frequently used agent (n=64), followed by vasopressin alone (n=26) and norepinephrine-vasopressin combination therapy (n=16).
Conclusion: Norepinephrine remains the most effective first-line vasopressor across shock phenotypes. Vasopressin appears beneficial as an adjunct in refractory septic shock but not as monotherapy in cardiogenic shock. Early escalation to combination therapy may improve outcomes in selected critically ill patients. Further multicenter randomized trials are required.