Up to one-third of all patients admitted to intensive care units carry a diagnosis
of shock. The use of angiotensin II is becoming widespread in all forms of shock,
including cardiogenic, after the U.S. Food and Drug Administration's (FDA's) initial
approval for vasoplegic shock in 2017. Here, the authors review the literature on
angiotensin II's mechanism of action, benefits, and future therapeutic opportunities.
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References
- FDA approval of angiotensin II for the treatment of hypotension in adults with distributive shock.Am J Cardiovasc Drugs. 2019; 19: 11-20
- Angiotensin II in Vasodilatory Shock.Crit Care Clin. 2019; 35: 229-245
- Intensity of Vasopressor Therapy For Septic Shock And The Risk Of In-Hospital Death.J Pain Symptom. 2017; 53: 938-943
- Renin-angiotensin system revisited.J Intern Med. 2008; 264: 224-236
- Inotropes and vasopressors: Review of physiology and clinical use in cardiovascular disease.Circulation. 2008; 118: 1047-1056
- Contemporary Management Of Cardiogenic Shock: A scientific statement from the American Heart Association.Circulation. 2017; 136: e232-e268
- Angiotensin II for the treatment of vasodilatory shock.N Engl J Med. 2017; 377: 419-430
- Angiotensin II brings more questions than answers.P T. 2018; 43: 685-687
- Angiotensin II and vasopressin for vasodilatory shock: A critical appraisal of catecholamine-sparing strategies.J Intensive Care Med. 2021; 36: 635-645
- Early on-cardiopulmonary bypass hypotension and other factors associated with vasoplegic syndrome.Circulation. 2009; 120: 1664-1671
- Risk assessment and outcomes of vasoplegia after cardiac surgery.Gen Thorac Cardiovasc Surg. 2017; 65: 557-565
- Association between vasopressor dependence and early outcome in patients after cardiac surgery.Anaesthesia. 2006; 61: 938-942
- The systemic inflammatory response to cardiopulmonary bypass: Pathophysiological, therapeutic, and pharmacological considerations.Anesth Analg. 1997; 85: 766-782
- Management of vasodilatory shock after cardiac surgery: Identification of predisposing factors and use of a novel pressor agent.J Thorac Cardiovasc Surg. 1998; 116: 973-980
- Perioperative infusion of low- dose of vasopressin for prevention and management of vasodilatory vasoplegic syndrome in patients undergoing coronary artery bypass grafting-A double-blind randomized study.J Cardiothorac Surg. 2010; 5: 17
- Vasopressin versus norepinephrine in patients with vasoplegic shock after cardiac surgery: The VANCS randomized controlled trial.Anesthesiology. 2017; 126: 85-93
- Treatment with angiotensin II Is associated with rapid blood pressure response and vasopressor sparing in patients with vasoplegia after cardiac surgery: A post-hoc analysis of angiotensin II for the treatment of high-output shock (ATHOS-3) Study.J Cardiothorac Vasc Anesth. 2021; 35: 51-58
- Hypotension as a risk factor for acute kidney injury in ICU patients.Comput Cardiol. 2010; 37: 1095-1098
- Association of arterial blood pressure and vasopressor load with septic shock mortality: A post hoc analysis of a multicenter trial.Crit Care. 2009; 13: R181
- Relation between mean arterial pressure and renal function in the early phase of shock: A prospective, explorative cohort study.Crit Care. 2011; 15: R135
- Angiotensin II: A new therapeutic option for vasodilatory shock.Ther Clin Risk Manag. 2018; 14: 1287-1298
- Outcomes in patients with vasodilatory shock and renal replacement therapy treated with intravenous angiotensin II.Crit Care Med. 2018; 46: 949-957
- Clinical experience with IV angiotensin II administration: A systematic review of safety.Crit Care Med. 2017; 45: 1285-1294
- A multicenter observational cohort study of angiotensin II in shock.J Intensive Care Med. 2022; 37: 75-82
- Therapeutic strategies for high-dose vasopressor-dependent shock.Crit Care Res Pract. 2013; 2013654708
- Refractory septic shock: Our pragmatic approach.Crit Care. 2018; 22: 215
- Angiotensin I and angiotensin II concentrations and their ratio in catecholamine-resistant vasodilatory shock.Crit Care. 2020; 24: 43
- The Use of Angiotensin II for the Treatment of Post-cardiopulmonary Bypass Vasoplegia.Cardiovasc Drugs Ther. 2020; https://doi.org/10.1007/s10557-020-07098-3
- Angiotensin II for Critically Ill Patients With Shock After Heart Transplant.J Cardiothorac Vasc Anesth. 2020; (S1053-0770(20)30792-8)
- Use of angiotensin II in Severe vasoplegia after left pneumonectomy requiring cardiopulmonary bypass: A renin response analysis.Crit Care Med. 2020; 48: e912-e915
- Catecholamine-sparing effect of angiotensin II in an anephric patient with mixed shock after cardiac revascularization surgery: A case report.A A Pract. 2020; 14: e01266
- Successful treatment of antihypertensive overdose using intravenous angiotensin II.J Emerg Med. 2019; 57: 339-344
U.S. National Library of Medicine - ClinicalTrials.gov. Angiotensin II Clinical Trials. Available at: https://clinicaltrials.gov/ct2/results?cond=&term=angiotensin+II&cntry=&state=&city=&dist=. Accessed March 30, 2021.
- Renin and survival in patients given angiotensin II for catecholamine-resistant vasodilatory shock. A clinical trial.Am J Respir Crit Care Med. 2020; 202: 1253-1261
- Renin, angiotensin II, and the journey to evidence-based individual treatment effects.Am J Respir Crit Care Med. 2020; 202: 1209-1210
- Administration of the nitric oxide synthase inhibitor NG-methyl-L-arginine hydrochloride (546C88) by intravenous infusion for up to 72 hours can promote the resolution of shock in patients with severe sepsis: Results of a randomized, double-blind, placebo-controlled multicenter study (study no. 144-002).Crit Care Med. 2004; 32: 1-12
- Multiple-center, randomized, placebo-controlled, double-blind study of the nitric oxide synthase inhibitor 546C88: Effect on survival in patients with septic shock.Crit Care Med. 2004; 32: 21-30
- Angiotensin II infusion for shock: A multicenter study of postmarketing use.Chest. 2021; 159: 596-605
- Underutilized fuel: Angiotensin II for vasoplegia in the heart failure patient population.J Cardiothorac Vasc Anesth. 2021; (S1053-0770(21)00330-X)
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Published online: July 16, 2021
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