Angiotensin II in vasodilatory shock: lights and shadows

Antonucci, Elio; Agosta, Sara; Sakr, Yasser

doi:10.1186/s13054-017-1869-9

Cited by 7 publications

(6 citation statements)

References 5 publications

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“…A recent literature review including 24 studies confirmed the effectiveness of AT-II at increasing blood pressure in all types of shock (21). However, the ATHOS-3 trial was not designed to detect a survival benefit from AT-II, and concerns exist on its safety profile (22). Thus, further large studies are still warranted to clarify those issues.…”

Section: Which Vasopressor Should Be Considered In Septic Shock?mentioning

confidence: 99%

“…A recent single-center RCT including 101 patients with septic shock admitted to the emergency department, compared the impact on survival of early NE initiation (along with fluid administration: early NE group) with late NE initiation (after the failure of 30 mL/kg crystalloids to achieve the MAP target). The NE infusion started after 25 [20][21][22][23][24][25][26][27][28][29][30] and 120 [120-180] min in the early NE and late NE groups, respectively (31). A significant difference in the in-hospital survival in favor of the early NE group was reported (31).…”

Section: When To Use Vasopressors? the Earlier The Bettermentioning

confidence: 99%

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Vasopressors in septic shock: which, when, and how much?

Shi¹,

Hamzaoui²,

Vita³

et al. 2020

Ann Transl Med

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In addition to fluid resuscitation, the vasopressor therapy is a fundamental treatment of septic shock-induced hypotension as it aims at correcting the vascular tone depression and then at improving organ perfusion pressure. Experts' recommendations currently position norepinephrine (NE) as the firstline vasopressor in septic shock. Vasopressin and its analogues are only second-line vasopressors as strong recent evidence suggests no benefit of their early administration in spite of promising preliminary data. Early administration of NE may allow achieving the initial mean arterial pressure (MAP) target faster and reducing the risk of fluid overload. The diastolic arterial pressure (DAP) as a marker of vascular tone, helps identifying the patients who need NE urgently. Available data suggest a MAP of 65 mmHg as the initial target but a more individualized approach is often required depending on several factors such as history of chronic hypertension or value of central venous pressure (CVP). In cases of refractory hypotension, increasing NE up to doses ≥1 µg/kg/min could be an option. However, current experts' guidelines suggest to combine NE with other vasopressors such as vasopressin, with the intent to rising the MAP to target or to decrease the NE dosage.

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Section: Which Vasopressor Should Be Considered In Septic Shock?mentioning

confidence: 99%

Section: When To Use Vasopressors? the Earlier The Bettermentioning

confidence: 99%

Vasopressors in septic shock: which, when, and how much?

Shi¹,

Hamzaoui²,

Vita³

et al. 2020

Ann Transl Med

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show abstract

“…Therefore, it remains to be determined whether improved haemodynamic parameters will translate in a survival benefit, especially considering long-term follow-up. Finally, optimal timing of administration, as well as specific subpopulation who may receive a particular benefit (eg, patients with cirrhosis) or harm (eg, patients with myocardial dysfunction), remains to be determined 8. Nevertheless, the ATHOS-3 study has now provided sufficient data to foster a subsequent larger randomised trial focusing on hard endpoints.…”

Section: Commentarymentioning

confidence: 99%

Angiotensin II increases blood pressure in patients with refractory vasodilatory shock

Landoni

Belletti²

2018

BMJ EBM

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“…No information on cardiac function was provided in this series, while the safety profile of Ang II has never been tested in patients with vasodilatory shock and severe concomitant myocardial dysfunction. Indeed, Ang II could reduce the cardiac output due to its vasoconstrictive properties and provide some detrimental effects on myocardial recovery [4].…”

mentioning

confidence: 99%