How Effective is Angiotensin II in Decreasing Mortality of Vasodilatory Shock? A Systematic Review

Patients with severe vasodilation accompanied by refractory hypotension despite high doses of vasopressors were associated with a high mortality rate. The Ang-2 for the Treatment of High-Output Shock (ATHOS) 3 trial demonstrated that angiotensin 2 (Ang-2) could effectively increase MAP and blood pre...

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Bibliographic Details
Published in:Open access emergency medicine 2023-01, Vol.15, p.1-11
Main Authors: Semedi, Bambang Pujo, Rehatta, Nancy Margarita, Soetjipto, Soetjipto, Nugraha, Jusak, Mahyuddin, Muhammad H, Arnindita, Jannatin N, Wairooy, Nabilah A P
Format: Article
Language:English
Subjects:
angiotensin ii
Bias
Blood vessels
Clinical outcomes
Clinical trials
Dilatation
Endocrine system
Hemodynamics
Hypotension
Indonesia
Medical research
Medicine, Experimental
Mortality
Patient outcomes
Review
Shock
Shock (Circulatory)
Systematic review
Vasodilators
vasodilatory shock
vasopressor
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Summary:Patients with severe vasodilation accompanied by refractory hypotension despite high doses of vasopressors were associated with a high mortality rate. The Ang-2 for the Treatment of High-Output Shock (ATHOS) 3 trial demonstrated that angiotensin 2 (Ang-2) could effectively increase MAP and blood pressure in vasodilatory shock patients. This systematic review aims to summarize the impact of Ang-2 for the treatment of vasodilatory shock on clinical outcomes, including length of stay, MAP level (before and after), and mortality also Ang-2 dose needed. A systematic search in PubMed, Sage, ScienceDirect, Scopus and Gray literature was conducted to obtain studies about the use of Ang-2 in vasodilatory shock patients. In all of the studies that we obtained, there were different results regarding mortality in patients with vasodilatory shock with Ang-2. Mortality was significantly lower when Ang-2 was administered to patients with elevated renin. The initial dose of Ang-2 can be started at 10-20 ng/kg/min, but there is no agreement on the maximum dose. Ang-2 may be considered a third-line vasopressor if the targeted MAP has not been achieved after administration of norepinephrine >200 ng/kg/min for more than 6 hours. Although not statistically significant, the use of Ang-2 can reduce the length of stay in the ICU and in the hospital when compared to patients without Ang-2 therapy, in addition to reducing the dose of vasopressor. Overall, the use of Ang-2 has potential to be a regimen for patients with vasodilatory shock. Further study is needed to obtain more data.
ISSN:1179-1500
1179-1500
DOI:10.2147/OAEM.S391167