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JAMA2025;333(19):1688-1698.May 20, 2025Journal Article

Optimal Vasopressin Initiation in Septic Shock: The OVISS Reinforcement Learning Study.

Alexandre Kalimouttou1,2,3, Jason N Kennedy4,5, Jean Feng6, Harvineet Singh6, Suchi Saria7,8,9,10,11, Derek C Angus4,5, Christopher W Seymour4,5, Romain Pirracchio1,2,6
1Inserm UMR 1153, Centre for Research in Epidemiology and Statistics (CRESS), ECSTRRA Team, Université Paris Cité and Université Sorbonne Paris Nord, Paris, France.
2Department of Anesthesia & Perioperative Care, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco.
3Department of Anesthesiology and Intensive Care Medicine, Grenoble Alpes University Hospital, Grenoble, France.
4Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
5Center for Research, Investigation, and Systems Modeling of Acute Illness, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
6Department of Epidemiology & Biostatistics, University of California, San Francisco.
7Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, Maryland.
8Department of Computer Science, Johns Hopkins University, Baltimore, Maryland.
9Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
10Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
11Bayesian Health, New York, New York.
PubMed PMC DOI PDF

Abstract

IMPORTANCE: Norepinephrine is the first-line vasopressor for patients with septic shock. When and whether a second agent, such as vasopressin, should be added is unknown. OBJECTIVE: To derive and validate a reinforcement learning model to determine the optimal initiation rule for vasopressin in adult, critically ill patients receiving norepinephrine for septic shock. DESIGN, SETTING, AND PARTICI…

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