Norepinephrine and Vasopressin for Rescue Versus Early Vasopressin for Vasopressor Dependent Sepsis

* Patients with vasopressor dependent sepsis, defined by infection suspicion and antibiotic administration or laboratory confirmed viral infection, plus hypotension with the need of vasopressors for at least one hour;

* Admitted or expected to be admitted to the ICU in the next 12 hours

* Adequate volume resuscitation in the opinion of the attending physician

* Use of norepinephrine > 0.05μg/Kg/min and ≤ 0.25μg/Kg/min for at least 1 hour and at most 24 hours at the time of inclusion

* Use of norepinephrine > 0.25μg/Kg/min in the last 24 hours, except when administered transiently in the context of sedation for a procedure or the initial phase of volume resuscitation for a period of less than one hour

* Dialysis-dependent chronic kidney disease or acute kidney injury that received renal replacement therapy during current hospitalization or are expected to receive renal replacement therapy in the next 24 hours

* Use of other vasopressors (except norepinephrine) at the moment of inclusion

* Use of vasopressors for sepsis in the last 7 days

* Suspected or confirmed acute mesenteric ischemia

* Anaphylaxis or known hypersensitivity to the study drug

* Expect to die in the next 24 hours

* Medical team not committed to full support at the time of inclusion

* Previous inclusion in the study