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Haemodynamic therapy in septic shock with non-adrenergic compounds such as the vasopressin-receptor agonist arginine vasopressin (AVP) [1], the calcium-sensitizer levosimendan [2], or beta-blockers [3] is gaining more and more attention since the potential negative effects of catecholamines in shock are well recognized [4]. The VANISH trial focused on the effects of AVP versus norepinephrine on renal failure (as the primary outcome) and mortality rates at 28 days and serious adverse events (as secondary outcomes) [1]. Although there might have been a potential benefit on kidney-failure-free days, overall the trial revealed no statistically significant differences regarding these outcomes. Thus, just another negative, randomised controlled trial in sepsis? Not at all!

VANISH: a challenge for current sepsis guidelines!