Angiotensin in Critical Care

Hall, Anna; Busse, Laurence W.; Ostermann, Marlies

doi:10.1186/s13054-018-1995-z

Cited by 48 publications

(48 citation statements)

References 47 publications

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Section: Angiotensin IImentioning

confidence: 99%

“…The renin‐angiotensin system (RAS) is a complex pathway responsible for maintaining arterial blood pressure and volume homeostasis . Although a comprehensive review of this pathway as well as all of the physiologic functions is beyond the scope of this article, a concise review of the proposed mechanisms of ATII as a vasoconstrictor is discussed here . Angiotensin II, an octapeptide, predominantly exerts direct arterial vasoconstriction by binding to the angiotensin (AT)‐1 receptors located on the vascular smooth muscle .…”

Section: Angiotensin IImentioning

confidence: 99%

“…Although a comprehensive review of this pathway as well as all of the physiologic functions is beyond the scope of this article, a concise review of the proposed mechanisms of ATII as a vasoconstrictor is discussed here . Angiotensin II, an octapeptide, predominantly exerts direct arterial vasoconstriction by binding to the angiotensin (AT)‐1 receptors located on the vascular smooth muscle . Other ATII‐mediated cardiovascular physiologic effects through the AT‐1 receptors potentially impacting arterial pressure homeostasis include the secretion of NE, vasopressin, and adrenocorticotropic hormone, as well as water and sodium reabsorption .…”

Section: Angiotensin IImentioning

confidence: 99%

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Catecholamine Vasopressor Support Sparing Strategies in Vasodilatory Shock

et al. 2019

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Shock syndromes are associated with unacceptably high rates of mortality in critically ill patients despite advances in therapeutic options. Vasodilatory shock is the most common type encountered in the intensive care unit. It is manifested by cardiovascular failure, peripheral vasodilatation, and arterial hypotension leading to tissue hypoperfusion and organ failure. Hemodynamic support is typically initiated with fluid resuscitation strategies and administration of adrenergic vasopressor agents in nonresponsive patients to restore arterial pressure with subsequent adequate organ reperfusion. Unfortunately, high catecholamine dosing requirements may be necessary to achieve targeted hemodynamic goals that may increase the risk of vasopressor‐induced adverse events. The purpose of this article is to review the clinical efficacy and safety data and potential role in therapy for catecholamine‐sparing agents in vasodilatory shock. Adjunctive therapeutic options to reduce vasoactive support requirements without compromising arterial pressure include arginine vasopressin and analogs, corticosteroids, midodrine, methylene blue, and angiotensin II. Although concomitant vasopressin and corticosteroids have a more defined role in evidence‐based guidelines for managing shock, clinicians may consider other potential catecholamine‐sparing agents.

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Section: Angiotensin IImentioning

confidence: 99%

Section: Angiotensin IImentioning

confidence: 99%

Section: Angiotensin IImentioning

confidence: 99%

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Catecholamine Vasopressor Support Sparing Strategies in Vasodilatory Shock

et al. 2019

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“…Activation of the AT1 receptor by angiotensin II also stimulates release of aldosterone, adrenocorticotropic hormone, NE, and vasopressin that contribute to the increase in blood pressure. Angiotensin II can also bind the angiotensin receptor type 2 leading to vasodilation and a counterbalancing of the vasoconstrictive effects of AT1 augmentation in some vascular beds . Despite these seemingly competing receptor effects on the vasculature, when exogenously administered, angiotensin II increases blood pressure.…”

Section: Adrs Of Angiotensin II and Risk Mitigationmentioning

confidence: 99%

“…Utilizing these therapies in patients who are not predicted to respond (whether a hemodynamic response, mortality benefit, or other definition) only subjects them to the potential for harm without the purported benefits. Reviews devoted to this topic exist in the literature, but some major points and nuances deserve discussion.…”

Section: Strategies To Minimize Adr Risk For Both Agentsmentioning

confidence: 99%

Safe Use of Vasopressin and Angiotensin II for Patients with Circulatory Shock

2018

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Circulatory shock is a medical emergency that requires rapid intervention to optimize patient outcomes. Although catecholamine vasopressors are considered life‐sustaining therapy, they are associated with adverse reactions, and vasopressin and angiotensin II may be used to minimize these adverse effects. However, vasopressin and angiotensin II are also associated with adverse reactions that must be known to the clinician to mitigate risk for patients. This review focuses on the known adverse drug effects of vasopressin and angiotensin II while offering potential solutions to minimize harm with these agents. Future directions with vasoactive medication safety including optimization of the electronic medical record, clinical decision support, prediction analytics, and precision medicine for patients with circulatory shock are also discussed.

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