Annals of the American Thoracic Society
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Rationale: A central component of septic shock treatment is the infusion of vasopressors, most commonly starting with norepinephrine. However, the optimal approach and practice patterns for initiating adjunctive vasopressors and corticosteroids are unknown. Objectives: To characterize practice pattern variation in the norepinephrine dose at which secondary vasopressors and adjunctive corticosteroids are initiated and to identify factors associated with a treatment strategy favoring secondary vasopressors compared with factors associated with a treatment strategy favoring adjunctive corticosteroids among patients with septic shock on norepinephrine. ⋯ The hospital of admission was strongly associated with receiving an additional-vasopressor-first strategy over a corticosteroid-first strategy (median odds ratio, 3.28 [95% CI, 2.81-3.83]). Conclusions: Practice patterns for adjunctive therapies to norepinephrine during septic shock are variable and are determined in large part by the hospital of admission. These results inform several future studies seeking to improve septic shock management.