Intravenous angiotensin II for the treatment of high-output shock (ATHOS trial): a pilot study |
| |
Authors: | Lakhmir S Chawla Laurence Busse Ermira Brasha-Mitchell Danielle Davison Jacqueline Honiq Ziyad Alotaibi Michael G Seneff |
| |
Affiliation: | .Division of Intensive Care Medicine and Division of Nephrology, Department of Medicine, Veterans Affairs Medical Center, 50 Irving Street, NW, Washington, DC USA ;.Section of Critical Care Medicine, Department of Medicine, Inova Fairfax Medical Center, Falls Church, VA USA ;.Department of Anesthesiology and Critical Care Medicine, George Washington Medical Center, Washington, DC USA ;.Prince Sultan Medical Military City, Critical Care and Emergency Medicine, Riyadh, Saudi Arabia |
| |
Abstract: | IntroductionPatients with distributive shock who require high dose vasopressors have a high mortality. Angiotensin II (ATII) may prove useful in patients who remain hypotensive despite catecholamine and vasopressin therapy. The appropriate dose of parenteral angiotensin II for shock is unknown.MethodsIn total, 20 patients with distributive shock and a cardiovascular Sequential Organ Failure Assessment score of 4 were randomized to either ATII infusion (N =10) or placebo (N =10) plus standard of care. ATII was started at a dose of 20 ng/kg/min, and titrated for a goal of maintaining a mean arterial pressure (MAP) of 65 mmHg. The infusion (either ATII or placebo) was continued for 6 hours then titrated off. The primary endpoint was the effect of ATII on the standing dose of norepinephrine required to maintain a MAP of 65 mmHg.ResultsATII resulted in marked reduction in norepinephrine dosing in all patients. The mean hour 1 norepinephrine dose for the placebo cohort was 27.6 ± 29.3 mcg/min versus 7.4 ± 12.4 mcg/min for the ATII cohort (P =0.06). The most common adverse event attributable to ATII was hypertension, which occurred in 20% of patients receiving ATII. 30-day mortality for the ATII cohort and the placebo cohort was similar (50% versus 60%, P =1.00).ConclusionAngiotensin II is an effective rescue vasopressor agent in patients with distributive shock requiring multiple vasopressors. The initial dose range of ATII that appears to be appropriate for patients with distributive shock is 2 to 10 ng/kg/min.Trial registrationClinicaltrials.gov {"type":"clinical-trial","attrs":{"text":"NCT01393782","term_id":"NCT01393782"}}NCT01393782. Registered 12 July 2011. |
| |
Keywords: | |
|
|