title: Catecholamines for inflammatory shock: a Jekyll-and-Hyde conundrum.
abstract: Catecholamines are endogenous neurosignalling mediators and hormones. They are integral in maintaining homeostasis by promptly responding to any stressor. Their synthetic equivalents are the current mainstay of treatment in shock states to counteract myocardial depression and/or vasoplegia. These phenomena are related in large part to decreased adrenoreceptor sensitivity and altered adrenergic signalling, with resultant vascular and cardiomyocyte hyporeactivity. Catecholamines are predominantly used in supraphysiological doses to overcome these pathological consequences. However, these adrenergic agents cause direct organ damage and have multiple 'off-target' biological effects on immune, metabolic and coagulation pathways, most of which are not monitored or recognised at the bedside. Such detrimental consequences may contribute negatively to patient outcomes. This review explores the schizophrenic 'Jekyll-and-Hyde' characteristics of catecholamines in critical illness, as they are both necessary for survival yet detrimental in excess. This article covers catecholamine physiology, the pleiotropic effects of catecholamines on various body systems and pathways, and potential alternatives for haemodynamic support and adrenergic modulation in the critically ill.
authors.affiliation: Division of Medicine, Bloomsbury Institute of Intensive Care Medicine, University College London, Gower St, London, WC1E 6BT, UK. davide.andreis@unimi.it.|Scuola di Specializzazione in Anestesia, Rianimazione e Terapia Intensiva, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, Italy. davide.andreis@unimi.it.
authors.forename: Davide Tommaso
authors.identifier: http://orcid.org/0000-0001-9415-5158
authors.initials: DT
authors.lastname: Andreis
authors.affiliation: Division of Medicine, Bloomsbury Institute of Intensive Care Medicine, University College London, Gower St, London, WC1E 6BT, UK.
authors.forename: Mervyn
authors.initials: M
authors.lastname: Singer
mesh_terms: D002319:Cardiovascular System / Q000187:drug effects; D002395:Catecholamines / Q000494:pharmacology* / Q000502:physiology; D016638:Critical Illness; D006706:Homeostasis / Q000187:drug effects; D006801:Humans; D009420:Nervous System / Q000187:drug effects; D012772:Shock, Septic / Q000188:drug therapy*
chemical_list: D002395:Catecholamines
keywords: Catecholamines; Critical illness; Epinephrine; Norepinephrine; Pathophysiology; Physiology; Sepsis