Angiotensin II (Giapreza): A Distinct Mechanism for the Treatment of Vasodilatory Shock
Septic shock, a form of vasodilatory shock associated with high morbidity and mortality, requires early and effective therapy to improve patient outcomes. Current management of septic shock includes the use of intravenous fluids, catecholamines, and vasopressin for hemodynamic support to ensure adequate perfusion. Despite these interventions, hospital mortality rates are still greater than 40%. Practitioners are continuously faced with cases of refractory shock that are associated with poor clinical outcomes. In December of 2017, the Food and Drug Administration approved the first synthetic human angiotensin II, a potent vasoconstrictor, to increase blood pressure in adults with septic or other distributive shock. This approval was based (ATHOS) on the results from the Angiotensin II for the Treatment of High Output Shock study. In this randomized, double-blind, placebo-controlled trial, patients in the angiotensin II group achieved higher rates of target mean arterial pressure and had lower catecholamine requirements in the first 3 hours of therapy compared with patients in the placebo group. There was no significant difference in the 28-day mortality. Safety issues including the risk of thromboembolic events, infection, and delirium have made clinicians cautious in adopting angiotensin II into practice. Ongoing studies are needed to more clearly define the role of this agent and its utility in the management of shock.
Condition: Trans Cranial Doppler Ultrasonography in Heamodynamic Optimisation in Septic Shock Intervention: Procedure: hemodynamic optimisation aiming to achieve normal cerebral perfusion Sponsor: Mongi Slim Hospital Recruiting
CONCLUSION: Determining pressure injury risk in critically ill patients is complex and challenging. One common pathophysiological factor is impaired tissue oxygenation and perfusion, which may be nonmodifiable. Improved risk quantification is needed and may be realized in the near future by leveraging the clinical information available in the electronic medical record through the power of predictive analytics. PMID: 32355967 [PubMed - in process]
Purpose of review Currently, the treatment of patients with shock is focused on the clinical symptoms of shock. In the early phase, this is usually limited to heart rate, blood pressure, lactate levels and urine output. However, as the ultimate goal of resuscitation is the improvement in microcirculatory perfusion the question is whether these currently used signs of shock and the improvement in these signs actually correspond to the changes in the microcirculation. Recent findings Recent studies have shown that during the development of shock the deterioration in the macrocirculatory parameters are followed by the de...
This study aimed to evaluate the association between hemodynamic and skin perfusion parameters and enteral nutrition therapy (NT) outcomes in septic shock patients.
In this study, gapCO2 induced by hyperventilation significantly increased, while the central venous carbon dioxide pressure (PvCO2) and the partial pressure of CO2 (PaCO2) in arteries decreased. The decreasing trend of the PaCO2 was more obvious than that of the PvCO2. HCO3− and ctCO2 were markedly decreased, when the RR was increased (P
Publication date: April 2020Source: Journal of Critical Care, Volume 56Author(s): Jean-Louis Vincent, Glenn Hernandez
Publication date: April 2020Source: Journal of Critical Care, Volume 56Author(s): Raúl J. Gazmuri, Cristina Añez de Gomez
Publication date: April 2020Source: Journal of Critical Care, Volume 56Author(s): Daniel De Backer, Jean-Louis Teboul, Bernd Saugel
Despite significant advancements in the management of septic shock, mortality rates remain high. Systemic vasodilation leading to inadequate tissue perfusion and in turn multi-organ failure leads to death. Strategic sepsis bundles were introduced by the 2016 Surviving Sepsis Campaign (SSC) and recommend antibiotics within 1 hour of onset and early and aggressive fluid resuscitation, as well as three and six-hour bundles to allow for re-evaluation. Vasopressor initiation to correct hemodynamic instability that is unresponsive to fluid resuscitation can occur at any number of points during resuscitation per the SSC rec...
We support a paradigm shift in the management of septic shock from pressure-guided to perfusion-centered, expected to improve outcome while reducing adverse effects from vasopressor therapy and aggressive fluid resuscitation. We propose focusing the hemodynamic management of septic shock on reversing organ hypoperfusion instead of attaining a predefined MAP target as the key strategy for improving outcome.