Angiotensin II Use in Refractory Multisystem Shock: A Case Report

Distributive (vasodilatory) shock is common in patients admitted to the intensive care unit (ICU). Treating distributive shock presents a challenge, especially if a patient is tachyphylactic to commonly used vasopressors. This case report illustrates the use of a newly approved vasopressor in a patient with vasodilatory shock resulting from a motor vehicle injury. A 56-year-old man was brought to our emergency department (ED) hemodynamically unstable requiring aggressive resuscitation. The results of his evaluation were consistent with multisystem trauma for which he required intubation on arrival, and he received multiple units of blood and blood product via transfusion. The patient’s condition declined despite receiving multiple vasopressors in the ICU. A few days after admission, the patient developed ischemic bowel requiring surgical resection. While his chance of survival was believed to be dismal, the use of angiotensin II (ATII) as a last resort proved to be helpful.