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Review
. 2024 Feb 21;4(1):13.
doi: 10.1186/s44158-024-00150-w.

Angiotensin ii therapy in refractory septic shock: which patient can benefit most? A narrative review

Irene Coloretti  1 , Andrea Genovese  2 , J Pedro Teixeira  3 , Anusha Cherian  4 , Ricard Ferrer  5 , Giovanni Landoni  6 , Marc Leone  7 , Massimo Girardis  2 , Nathan D Nielsen  8
Affiliations
Review

Angiotensin ii therapy in refractory septic shock: which patient can benefit most? A narrative review

Irene Coloretti et al. J Anesth Analg Crit Care. .

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.

Keywords: Angiotensin II; Refractory shock; Septic shock; Vasopressors.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Clinical indications for considering the use of Angiotensin II in critically ill patients with septic shock or other distributive shock (left). Dose and clinical effects in specific sub-populations of Angiotensin II therapy (right)
See this image and copyright information in PMC

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