A Retrospective Review of Angiotensin II Use in Adult Patients With Refractory Distributive Shock

Abstract

Purpose: Catecholamines are first-line vasopressors for hemodynamic support in distributive shock but are associated with adverse effects, which may be mitigated with noncatecholamine vasopressors. Angiotensin II (ATII) is a noncatecholamine vasopressor recently approved for the management of distributive shock, but limited data support its clinical utility. The purpose of this study was to describe our institution’s usage of ATII including patient outcomes (eg, response to therapy, safety profile). Materials and Methods: Patients who received ATII at our institution were included. Patient demographics, degree of concordance with institutional ATII use guidelines, safety profile of ATII, and response to therapy (1 and 3 hours after ATII initiation) were collected. Results: A total of 16 patients received ATII for distributive shock. The median Sequential Organ Failure Assessment score at the time of ATII initiation was 16.5 (interquartile range: 15.8-20.0). Fourteen (87.5%) patients met institutional guidelines for ATII use; 10 (62.5%) and 8 (50.0%) patients met our definition for response at 1 and 3 hours, respectively. No patients developed thrombotic or infectious complications after receiving ATII. Conclusions: In this cohort, ATII appears to be well tolerated in patients with a high predicted mortality. Future studies evaluating the clinical efficacy of ATII are needed to determine its role in the management of distributive shock.

A Multicenter Observational Cohort Study of Angiotensin II in Shock

“…These results are statistically and clinically important because, contemporary evidence examining the use of human Ang-2 is mainly from the ATHOS-3 trial and its subsequent post-hoc analyses. 3,[9][10][11][12][13][14][15][16] Our study includes patients with a wide variety of shock states, including cardiogenic and hypovolemic shock, which were not studied in ATHOS-3.…”

“…[9][10][11][12] With the exception of case reports, small case series, and 1 multicenter study, studies occurring after ATHOS-3 that have not been derived from that study's dataset are sparse. [13][14][15][16][17] The purpose of our multicenter study was to assess the effectiveness of Ang-2 for the treatment of shock. Specifically, we sought to evaluate whether Ang-2 effectively increases MAP and decreases NEpi-equivalent dose.…”

How Effective is Angiotensin II in Decreasing Mortality of Vasodilatory Shock? A Systematic Review

“…They also added that the doctors are reluctant to use Ang-2 in the treatment of shock due to lack of familiarity with this new vasopressor and uncertainty about its availability and adjustment for use. 37 In this systematic review study, we found that Ang-2 was able to increase MAP above 65mmHg. 3,[12][13][14] Ang-2 binds to AT-I causing vasoconstriction in both afferent and efferent glomerular arterioles.…”

“…Wong et al noted that the dosing of Ang-2 was often not in accordance with the recommendations in the protocol, especially with regard to the maximum dose. 37 They stated that although the institution had determined the Ang-2 administration protocol, in practice this was up to the attending physician to determine the timing of initiation and dose modification. They also added that the doctors are reluctant to use Ang-2 in the treatment of shock due to lack of familiarity with this new vasopressor and uncertainty about its availability and adjustment for use.…”

“…They also added that the doctors are reluctant to use Ang-2 in the treatment of shock due to lack of familiarity with this new vasopressor and uncertainty about its availability and adjustment for use. 37 …”