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Angiotensin II: a new therapeutic option for vasodilatory shock

Authors Bussard RL, Busse LW

Received 7 April 2018

Accepted for publication 10 June 2018

Published 26 July 2018 Volume 2018:14 Pages 1287—1298

DOI https://doi.org/10.2147/TCRM.S150434

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Professor Garry Walsh


Rachel L Bussard,1 Laurence W Busse2,3

1Critical Care Pharmacy Specialist, Department of Pharmacy, Emory St Joseph’s Hospital, Atlanta, GA, USA; 2Department of Critical Care, Emory St Joseph’s Hospital, Atlanta, GA, USA; 3Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA, USA

Abstract: Angiotensin II (Ang II), part of the renin–angiotensin–aldosterone system (RAS), is a potent vasoconstrictor and has been recently approved for use by the US Food and Drug Administration in high-output shock. Though not a new drug, the recently published Angiotensin II for the Treatment of High Output Shock (ATHOS-3) trial, as well as a number of retrospective analyses have sparked renewed interest in the use of Ang II, which may have a role in treating refractory shock. We describe refractory shock, the unique mechanism of action of Ang II, RAS dysregulation in shock, and the evidence supporting the use of Ang II to restore blood pressure. Evidence suggests that Ang II may preferentially be of benefit in acute kidney injury and acute respiratory distress syndrome, where the RAS is known to be disrupted. Additionally, there may be a role for Ang II in cardiogenic shock, angiotensin converting enzyme inhibitor overdose, cardiac arrest, liver failure, and in settings of extracorporeal circulation.

Keywords:
catecholamine resistance, refractory shock

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