Modern Vasopressor Therapy of Septic Shock (Review)

Abstract

Septic shock, as the most severe form of sepsis, is characterized by high mortality reaching 40% despite the use of the most modern standards of diagnosis and treatment. In the thanatogenesis of septic shock, vasoplegia plays a leading role, respectively, and therapy of the condition under discussion involves the use of vasoconstrictors, along with the standard prescription of infusion therapy, antibiotics and symptomatic treatment. The choice of a specific vasoactive drug is a difficult task for a practicing anesthetist, as along with undoubtedly positive properties, vasoconstrictors each have their own spectrum of undesirable side effects, which, of course, must be taken into account when determining treatment tactics.The aim of review: A comprehensive assessment of the multifactorial effect of various vasoconstrictors on the patient to determine the criteria for choosing the optimal drug (or a combination of drugs) in septic shock.The search was carried out using PubMed and Scopus databases, the final selection of 89 articles was carried out in accordance with the following criteria: relevance to the topic of this review and the nature of the article — only randomized controlled trials, guidelines and analytical reviews were included in the final analysis.External and internal mechanisms of vascular tone regulation are considered, including factors produced by endothelium (nitric oxide, prostacyclin, endothelin); vasoactive metabolites and autocoids — signal molecules of local action (serotonin, prostaglandins, thromboxane A2). Accordingly, drugs were analyzed the mechanism of action of which is related to the effect on adrenergic (adrenaline, dopamine, norepinephrine, phenylephrine, dobutamine), vasopressin (vasopressin, terlipressin, selepressin) receptors, synthetic analogues of angiotensin (angiotensin II) and drugs the non-vasopressor effect of which is not linked with the receptor apparatus (methylene blue, levosimendan, hydrocortisone).Conclusion. The high effectiveness of norepinephrine, its positive hemodynamic effects make the drug under discussion, in many ways, a universal remedy for the relief of septic shock. However, refractory shock may require the introduction of such high doses of norepinephrine that the occurrence of adverse reactions will become practically inevitable. The combined use of adrenergic and ligand V receptors, terlipressin, is intended to prevent these complications. However, to date, there are no clear recommendations on the use of terlipressin in septic shock, which limits its use in clinical practice.

Use of Sorbent Based on Hypercrosslinked Styrene-Divinylbenzene Copolymer With Immobilized LPS-Selective Ligand In Hemoperfusion For Treatment of Patients With Septic Shock

“…Taking into account the key role of bacterial endotoxins in the pathogenesis of septic shock and the absence of a significant trend for reducing mortality in response to the medication treatment [26][27][28][29], increasing interest is being focused on extracorporeal methods of clearing the endotoxins and inflammatory immune mediators from the bloodstream [30][31][32]. Such methods are designed to reduce the levels of pathogenetically significant molecules in the systemic circulation down to less critical values at least for a certain period of time in order to enable the immune system and antibiotics to reduce the bacterial load and the production of new endotoxin molecules [33][34][35][36][37][38][39][40][41][42][43][44][45].…”

“…Such methods are designed to reduce the levels of pathogenetically significant molecules in the systemic circulation down to less critical values at least for a certain period of time in order to enable the immune system and antibiotics to reduce the bacterial load and the production of new endotoxin molecules [33][34][35][36][37][38][39][40][41][42][43][44][45]. летальности при применения лекарственной терапии [26][27][28][29], возрастающий интерес уделяется экстракорпоральным методам удаления эндотоксинов и воспалительных медиаторов иммунного ответа из кровотока [30][31][32]. Такие методы призваны снизить в системном кровотоке содержание патогенетически значимых для жизнеугрожающих состояний молекул до менее критичных значений хотя бы на определенное время, чтобы дать возможность иммунной системе и антибиотикам обеспечить снижение бактериальной нагрузки, а значит -и продукции новых молекул эндотоксина [33][34][35].…”