Early Triple Vasopressors Accelerate Renin and Lactate Clearance in Septic Shock

TRICYCLE is the first randomized trial to test simultaneous angiotensin II, vasopressin, and norepinephrine at the onset of catecholamine-refractory septic shock, offering ICU pharmacists early physiologic signal data before any mortality verdict.

angiotensin IIvasopressinnorepinephrinevasopressorsseptic shockreninlactateSOFAtachyarrhythmiaphase II RCThemodynamicsTRICYCLESurviving Sepsis Campaign Critical Care / ICU

Background Information

Early multimodal vasopressor therapy shows promise in septic shock management.

Septic shock requires prompt management, and finding effective vasopressor strategies can improve patient outcomes and reduce ICU mortality. Early multimodal vasopressor therapy led to faster declines in plasma renin and lactate concentrations and lower incidences of tachyarrhythmias compared to traditional therapy. While physiological benefits were observed, the study was not powered to demonstrate differences in mortality, indicating the need for larger trials to evaluate patient-centered outcomes. Early multimodal vasopressor therapy shows promising physiological benefits in septic shock management.

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Authors: Kalamar Ž, Landoni G, Gorenjak M, Cestar I, Fluher J, Horvat M, Jerenec K, Kit B, Marinšek M, Puklavec N, Svenšek F, Radonić R, Šundalić S, Brajković AV, Vujević A, Erjavc N, Petek D, Košir AS, Homšak E, Knehtl MC, Markota A

Citation: Kalamar Ž, Landoni G, Gorenjak M, et al. Early multimodal vasopressor strategy in septic shock: results of the TRICYCLE randomized controlled trial. Critical care (London, England). 2026;30(1). doi:10.1186/s13054-026-06323-z

Article Links: PubMed · Journal / DOI · Free Full Text (PMC)

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