Abstract
Purpose
Angiotensin II (ATII) is a potent endogenous vasoconstrictor that has recently garnered
regulatory approval for the treatment of distributive shock, including septic shock.
Traditional vasoactive substances used in the management of distributive shock include
norepinephrine, epinephrine, phenylephrine, and vasopressin. However, their use can
be associated with deleterious adverse drug effects, such as splanchnic vasoconstriction
and associated hypoperfusion. The purpose of this review is to describe ATII, including
its pharmacologic mechanisms, pharmacokinetic profile, evidence of efficacy and tolerability,
and potential role in contemporary critical care practice.
Methods
Peer-reviewed clinical trials and relevant treatment guidelines published from 1966
to September 14, 2019, were identified from Medline/PubMed using the following search
terms: angiotensin II OR angiotensin 2 AND shock OR septic shock OR vasodilatory shock. Pertinent review articles were reviewed for additional studies for inclusion and
discussion. The final decision on the inclusion of studies in the current review was
based on the expert opinion of the authors.
Findings
On the basis of the available evidence, ATII is effective at elevating blood pressure
in patients with distributive shock and appears to reduce the dose of concurrent vasopressors
to maintain adequate blood pressure. ATII has been investigated for other causes of
shock; however, robust evidence of off-label indications is lacking and is much needed.
Clinical and cost benefits compared with traditional vasopressors have yet to be established.
Implications
ATII represents a welcome addition to the armamentarium of critical care clinicians.
Enthusiasm for the use of ATII should be balanced with the current gaps in our understanding
of ATII in patients with shock. Until further evidence provides more clinically meaningful
benefits, as well as cost-effectiveness compared with currently available vasopressors,
critical care clinicians should reserve ATII for salvage therapy in patients with
septic shock.
Key words
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Article Info
Publication History
Published online: October 24, 2019
Accepted:
September 24,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
