The VASST trial compared low-dose vasopressin with norepinephrine as an adjunct to open-label vasopressor therapy in patients with septic shock. The central question was whether adding vasopressin-based support could lower mortality compared with further norepinephrine. In the overall trial population, vasopressin did not significantly reduce 28-day or 90-day mortality. A prospectively defined subgroup with less severe shock appeared to have lower mortality with vasopressin, but the interaction was not statistically conclusive, so the result should not be used to define a routine subgroup-specific strategy. The trial also illustrates an important feature of vasopressor selection: the choice of agent is about more than simply reaching a blood-pressure target. Catecholamine exposure, vascular tone, organ perfusion and adverse effects all matter. In current practice, vasopressin is generally considered an adjunct rather than a replacement for norepinephrine in refractory septic shock. The VASST findings remain relevant because they discourage the assumption that switching vasopressor class automatically changes survival. For clinicians, the practical focus remains achieving adequate perfusion pressure while minimising treatment-related harm and repeatedly reassessing whether the haemodynamic problem is vasodilation, inadequate preload, myocardial dysfunction or another contributor to shock.