A Blast From the Past: Revival of Angiotensin II for Vasodilatory Shock

Bissell, Brittany D; Browder, Kelsey; McKenzie, Matthew; Flannery, Alexander H.

doi:10.1177/1060028018767899

Cited by 10 publications

(8 citation statements)

References 40 publications

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“…Most importantly, in vascular smooth muscle, stimulation results in direct arterial and venous vasoconstriction and an increase in systemic blood pressure, in addition to increased vascular permeability. 5,6 In the renal structures, angiotensin II stimulates sodium reabsorption and aldosterone release; in the pituitary, there is stimulation of vasopressin secretion from the posterior gland and adrenocorticotropic hormone secretion from the anterior gland; and in the cerebral circulation, there is stimulation of endogenous norepinephrine secretion. 5,6 Even though catecholamines are known to constrict the mesenteric vasculature, it has been suggested that angiotensin II may mobilize venous blood from the mesenteric circulation and in turn increase preload and promote lactate clearance.…”

Section: Discussionmentioning

confidence: 99%

“…4 Angiotensin II acts directly on vessel walls, resulting in vasoconstriction and, most importantly, a rise in mean arterial pressure (MAP)-independent of adrenergic stimulation. 5,6 Given this, herein the authors report their experience with the use of synthetic human angiotensin II infusion for vasopressor refractory vasoplegic shock in patients undergoing cardiothoracic surgery requiring CPB. In all cases, a MAP of at least 65 mmHg was targeted with angiotensin II infusion, and norepinephrine was preferentially down-titrated as hemodynamics allowed.…”

mentioning

confidence: 99%

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Synthetic Human Angiotensin II for Postcardiopulmonary Bypass Vasoplegic Shock

Wieruszewski

Radosevich

Kashani

et al. 2019

Journal of Cardiothoracic and Vascular Anesthesia

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Synthetic Human Angiotensin II for Postcardiopulmonary Bypass Vasoplegic Shock

Wieruszewski

Radosevich

Kashani

et al. 2019

Journal of Cardiothoracic and Vascular Anesthesia

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“…Sepsis also leads to an imbalance between vascular mediators. Vasodilating factors (e.g., nitric oxide, tumor necrosis factor-α, histamine, kinins, and prostaglandins) are released, whereas the vasoconstrictor response to ATII and catecholamines might decrease [5-6]. Refractory septic shock is associated with impaired microvascular flow and reduced capillary density at sub pressor levels [7].…”

Section: Discussionmentioning

confidence: 99%

Angiotensin II Use in Refractory Multisystem Shock: A Case Report

Ahmed

Habis

Mahmoud

et al. 2018

Cureus

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Distributive (vasodilatory) shock is common in patients admitted to the intensive care unit (ICU). Treating distributive shock presents a challenge, especially if a patient is tachyphylactic to commonly used vasopressors. This case report illustrates the use of a newly approved vasopressor in a patient with vasodilatory shock resulting from a motor vehicle injury. A 56-year-old man was brought to our emergency department (ED) hemodynamically unstable requiring aggressive resuscitation. The results of his evaluation were consistent with multisystem trauma for which he required intubation on arrival, and he received multiple units of blood and blood product via transfusion. The patient’s condition declined despite receiving multiple vasopressors in the ICU. A few days after admission, the patient developed ischemic bowel requiring surgical resection. While his chance of survival was believed to be dismal, the use of angiotensin II (ATII) as a last resort proved to be helpful.

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“…The newest agent approved by the US Food and Drug Administration (FDA) for sepsis and other vasodilatory shock is synthetic human angiotensin II (ATII), which offers a novel mechanism of action by promoting vasoconstriction and fluid retention through the renin-angiotensin-aldosterone system. 25 The drug was granted FDA approval based on results of the Angiotensin II for the Treatment of High-Output Shock (ATHOS-3) study. 26 A total of 321 patients were enrolled to receive ATII or placebo in addition to vasopressors.…”

Section: Angiotensin IImentioning

confidence: 99%

Strategies for the Management of Sepsis

Gilbert

Reichert

Fletcher

2019

AACN Advanced Critical Care

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T he incidence of sepsis and mortality rates have remained consistent over the years despite advances in therapy, with mortality rates reported to be as high as 23.6% for patients diagnosed with septic shock. 1,2 However, since 2014, how we identify sepsis and how we treat affected patients has changed substantially. 3,4 In addition, although the topic is beyond the scope of this article, controversy remains about which criteria should be used when screening for and diagnosing sepsis. 5 The purpose of this article is to provide an overview of some of the updates to the Surviving Sepsis Campaign (SSC) guidelines, adjustments in traditional approaches to the management of sepsis, and novel therapies that have yet to be described extensively in the literature, such as the use of ascorbic acid, thiamine, and angiotensin II. Surviving Sepsis Campaign Updates The main update in the 2016 SSC guideline recommendations was that the use of early goal-directed therapy (EGDT) did not confer a mortality benefit compared with standard of care. 6 In the important studies on which the 2016 SSC recommendations were based, the framework of EGDT was still used in the standard-of-care groups (early antibiotic administration and fluids for patients with hypotension); however, dynamic variables to assess fluid responsiveness were promoted over the use of static variables. 4 In 2018 the SSC released another update to their guidelines, recommending that fluid resuscitation and antibiotics should not be lumped into 3-and 6-hour bundles, but should be started within 1 hour of recognition of possible sepsis or septic shock. 7 However, whether this strategy should be considered a best practice remains controversial. In May 2018, the Infectious Diseases Society of America (IDSA) responded by not endorsing the SSC guidelines, especially as they pertained to a strict 1-hour bundle, because of concerns that a significant percentage of patients might receive antibiotics who are not actually infected. 8 By September 2018, additional concerns had been raised related to the release of the 1-hour bundle; the Society of Critical Care Medicine and the American College of Emergency Physicians released a joint statement advising that hospitals in the United States should not implement the 1-hour bundle

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A Blast From the Past: Revival of Angiotensin II for Vasodilatory Shock

Abstract: AT-II is a newly available vasoactive agent with a novel mechanism for the treatment of distributive shock. Further research is needed to define its exact role in therapy of shock states, identify patients most likely to benefit, and further study its safety profile in critical illness.

Cited by 10 publications

References 40 publications

Synthetic Human Angiotensin II for Postcardiopulmonary Bypass Vasoplegic Shock

Synthetic Human Angiotensin II for Postcardiopulmonary Bypass Vasoplegic Shock

Angiotensin II Use in Refractory Multisystem Shock: A Case Report

Strategies for the Management of Sepsis

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