Angiotensin II therapy in refractory septic shock: which patient can benefit most? A narrative review
Abstract Patients with septic shock who experience refractory hypotension despite adequate fluid resuscitation and high-dose noradrenaline have high mortality rates. To improve outcomes, evidence-based guidelines recommend starting a second vasopressor, such as vasopressin, if noradrenaline doses ex...
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| Format: | Article |
| Language: | English |
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BMC
2024-02-01
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| Series: | Journal of Anesthesia, Analgesia and Critical Care |
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| Online Access: | https://doi.org/10.1186/s44158-024-00150-w |
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| author | Irene Coloretti Andrea Genovese J. Pedro Teixeira Anusha Cherian Ricard Ferrer Giovanni Landoni Marc Leone Massimo Girardis Nathan D. Nielsen |
| author_facet | Irene Coloretti Andrea Genovese J. Pedro Teixeira Anusha Cherian Ricard Ferrer Giovanni Landoni Marc Leone Massimo Girardis Nathan D. Nielsen |
| author_sort | Irene Coloretti |
| collection | DOAJ |
| description | Abstract Patients with septic shock who experience refractory hypotension despite adequate fluid resuscitation and high-dose noradrenaline have high mortality rates. To improve outcomes, evidence-based guidelines recommend starting a second vasopressor, such as vasopressin, if noradrenaline doses exceed 0.5 µg/kg/min. Recently, promising results have been observed in treating refractory hypotension with angiotensin II, which has been shown to increase mean arterial pressure and has been associated with improved outcomes. This narrative review aims to provide an overview of the pathophysiology of the renin-angiotensin system and the role of endogenous angiotensin II in vasodilatory shock with a focus on how angiotensin II treatment impacts clinical outcomes and on identifying the population that may benefit most from its use. |
| format | Article |
| id | doaj-art-ead94547494748ffa7338ca90b361cb6 |
| institution | DOAJ |
| issn | 2731-3786 |
| language | English |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Anesthesia, Analgesia and Critical Care |
| spelling | doaj-art-ead94547494748ffa7338ca90b361cb62025-08-20T03:10:56ZengBMCJournal of Anesthesia, Analgesia and Critical Care2731-37862024-02-01411910.1186/s44158-024-00150-wAngiotensin II therapy in refractory septic shock: which patient can benefit most? A narrative reviewIrene Coloretti0Andrea Genovese1J. Pedro Teixeira2Anusha Cherian3Ricard Ferrer4Giovanni Landoni5Marc Leone6Massimo Girardis7Nathan D. Nielsen8Anesthesia and Intensive Care Medicine, Policlinico Di Modena, University of Modena and Reggio EmiliaAnesthesia and Intensive Care Medicine, Policlinico Di Modena, University of Modena and Reggio EmiliaDivisions of Nephrology and Pulmonary, Critical Care, and Sleep Medicine, University of New Mexico School of MedicineAnesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)Intensive Care Department, Hospital Universitari Vall d’HebronAnesthesia and Intensive Care, IRCCS San Raffaele Scientific InstituteAnesthesia and Intensive Care Medicine, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille UniversitéAnesthesia and Intensive Care Medicine, Policlinico Di Modena, University of Modena and Reggio EmiliaDivision of Pulmonary, Critical Care and Sleep Medicine & Section of Transfusion Medicine and Therapeutic Pathology, University of New Mexico School of MedicineAbstract Patients with septic shock who experience refractory hypotension despite adequate fluid resuscitation and high-dose noradrenaline have high mortality rates. To improve outcomes, evidence-based guidelines recommend starting a second vasopressor, such as vasopressin, if noradrenaline doses exceed 0.5 µg/kg/min. Recently, promising results have been observed in treating refractory hypotension with angiotensin II, which has been shown to increase mean arterial pressure and has been associated with improved outcomes. This narrative review aims to provide an overview of the pathophysiology of the renin-angiotensin system and the role of endogenous angiotensin II in vasodilatory shock with a focus on how angiotensin II treatment impacts clinical outcomes and on identifying the population that may benefit most from its use.https://doi.org/10.1186/s44158-024-00150-wAngiotensin IISeptic shockRefractory shockVasopressors |
| spellingShingle | Irene Coloretti Andrea Genovese J. Pedro Teixeira Anusha Cherian Ricard Ferrer Giovanni Landoni Marc Leone Massimo Girardis Nathan D. Nielsen Angiotensin II therapy in refractory septic shock: which patient can benefit most? A narrative review Journal of Anesthesia, Analgesia and Critical Care Angiotensin II Septic shock Refractory shock Vasopressors |
| title | Angiotensin II therapy in refractory septic shock: which patient can benefit most? A narrative review |
| title_full | Angiotensin II therapy in refractory septic shock: which patient can benefit most? A narrative review |
| title_fullStr | Angiotensin II therapy in refractory septic shock: which patient can benefit most? A narrative review |
| title_full_unstemmed | Angiotensin II therapy in refractory septic shock: which patient can benefit most? A narrative review |
| title_short | Angiotensin II therapy in refractory septic shock: which patient can benefit most? A narrative review |
| title_sort | angiotensin ii therapy in refractory septic shock which patient can benefit most a narrative review |
| topic | Angiotensin II Septic shock Refractory shock Vasopressors |
| url | https://doi.org/10.1186/s44158-024-00150-w |
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