title: Angiotensin II in Refractory Septic Shock.
abstract: Refractory septic shock is defined as persistently low mean arterial blood pressure despite volume resuscitation and titrated vasopressors/inotropes in patients with a proven or suspected infection and concomitant organ dysfunction. Its management typically requires high doses of catecholamines, which can induce significant adverse effects such as ischemia and arrhythmias. Angiotensin II (Ang II), a key product of the renin-angiotensin-aldosterone system, is a vasopressor agent that could be used in conjunction with other vasopressors to stabilize critically ill patients during refractory septic shock, and reduce catecholamine requirements. However, very few clinical data are available to support Ang II administration in this setting. Here, we review the current literature on this topic to better understand the role of Ang II administration during refractory septic shock, differentiating experimental from clinical studies. We also consider the potential role of exogenous Ang II administration in specific organ dysfunction and possible pitfalls with Ang II in sepsis. Various issues remain unresolved and future studies should investigate important topics such as: the optimal dose and timing of Ang II administration, a comparison between Ang II and the other vasopressors (epinephrine; vasopressin), and Ang II effects on microcirculation.
authors.affiliation: *Intermediate Care Unit, Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy †Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium ‡Department of Internal Medicine, University Hospital of Patras, Rion, Greece §Department of Medical Biotechnologies, University of Siena, Siena, Italy ||Cardiothoracic Anesthesia and Intensive Care Unit, Siena University Hospital, Siena, Italy.
authors.forename: Elio
authors.initials: E
authors.lastname: Antonucci
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Gleeson
authors.forename: Filippo
authors.initials: F
authors.lastname: Annoni
authors.forename: Sara
authors.initials: S
authors.lastname: Agosta
authors.forename: Sergio
authors.initials: S
authors.lastname: Orlando
authors.forename: Fabio Silvio
authors.initials: FS
authors.lastname: Taccone
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Velissaris
authors.forename: Sabino
authors.initials: S
authors.lastname: Scolletta
mesh_terms: D000804:Angiotensin II / Q000627:therapeutic use*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D012772:Shock, Septic / Q000188:drug therapy* / Q000378:metabolism*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents; D000804:Angiotensin II