Cargando…

Alternatives to norepinephrine in septic shock: Which agents and when?

Vasopressors are the cornerstone of hemodynamic management in patients with septic shock. Norepinephrine is currently recommended as the first-line vasopressor in these patients. In addition to norepinephrine, there are many other potent vasopressors with specific properties and/or advantages that a...

Descripción completa

Detalles Bibliográficos
Autor principal: Jozwiak, Mathieu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9924015/
https://www.ncbi.nlm.nih.gov/pubmed/36788938
http://dx.doi.org/10.1016/j.jointm.2022.05.001
_version_ 1784887816062238720
author Jozwiak, Mathieu
author_facet Jozwiak, Mathieu
author_sort Jozwiak, Mathieu
collection PubMed
description Vasopressors are the cornerstone of hemodynamic management in patients with septic shock. Norepinephrine is currently recommended as the first-line vasopressor in these patients. In addition to norepinephrine, there are many other potent vasopressors with specific properties and/or advantages that act on vessels through different pathways after activation of specific receptors; these could be of interest in patients with septic shock. Dopamine is no longer recommended in patients with septic shock because its use is associated with a higher rate of cardiac arrhythmias without any benefit in terms of mortality or organ dysfunction. Epinephrine is currently considered as a second-line vasopressor therapy, because of the higher rate of associated metabolic and cardiac adverse effects compared with norepinephrine; however, it may be considered in settings where norepinephrine is unavailable or in patients with refractory septic shock and myocardial dysfunction. Owing to its potential effects on mortality and renal function and its norepinephrine-sparing effect, vasopressin is recommended as second-line vasopressor therapy instead of norepinephrine dose escalation in patients with septic shock and persistent arterial hypotension. However, two synthetic analogs of vasopressin, namely, terlipressin and selepressin, have not yet been employed in the management of patients with septic shock, as their use is associated with a higher rate of digital ischemia. Finally, angiotensin Ⅱ also appears to be a promising vasopressor in patients with septic shock, especially in the most severe cases and/or in patients with acute kidney injury requiring renal replacement therapy. Nevertheless, due to limited evidence and concerns regarding safety (which remains unclear because of potential adverse effects related to its marked vasopressor activity), angiotensin Ⅱ is currently not recommended in patients with septic shock. Further studies are needed to better define the role of these vasopressors in the management of these patients.
format Online
Article
Text
id pubmed-9924015
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-99240152023-02-13 Alternatives to norepinephrine in septic shock: Which agents and when? Jozwiak, Mathieu J Intensive Med Review Vasopressors are the cornerstone of hemodynamic management in patients with septic shock. Norepinephrine is currently recommended as the first-line vasopressor in these patients. In addition to norepinephrine, there are many other potent vasopressors with specific properties and/or advantages that act on vessels through different pathways after activation of specific receptors; these could be of interest in patients with septic shock. Dopamine is no longer recommended in patients with septic shock because its use is associated with a higher rate of cardiac arrhythmias without any benefit in terms of mortality or organ dysfunction. Epinephrine is currently considered as a second-line vasopressor therapy, because of the higher rate of associated metabolic and cardiac adverse effects compared with norepinephrine; however, it may be considered in settings where norepinephrine is unavailable or in patients with refractory septic shock and myocardial dysfunction. Owing to its potential effects on mortality and renal function and its norepinephrine-sparing effect, vasopressin is recommended as second-line vasopressor therapy instead of norepinephrine dose escalation in patients with septic shock and persistent arterial hypotension. However, two synthetic analogs of vasopressin, namely, terlipressin and selepressin, have not yet been employed in the management of patients with septic shock, as their use is associated with a higher rate of digital ischemia. Finally, angiotensin Ⅱ also appears to be a promising vasopressor in patients with septic shock, especially in the most severe cases and/or in patients with acute kidney injury requiring renal replacement therapy. Nevertheless, due to limited evidence and concerns regarding safety (which remains unclear because of potential adverse effects related to its marked vasopressor activity), angiotensin Ⅱ is currently not recommended in patients with septic shock. Further studies are needed to better define the role of these vasopressors in the management of these patients. Elsevier 2022-06-12 /pmc/articles/PMC9924015/ /pubmed/36788938 http://dx.doi.org/10.1016/j.jointm.2022.05.001 Text en © 2022 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Review
Jozwiak, Mathieu
Alternatives to norepinephrine in septic shock: Which agents and when?
title Alternatives to norepinephrine in septic shock: Which agents and when?
title_full Alternatives to norepinephrine in septic shock: Which agents and when?
title_fullStr Alternatives to norepinephrine in septic shock: Which agents and when?
title_full_unstemmed Alternatives to norepinephrine in septic shock: Which agents and when?
title_short Alternatives to norepinephrine in septic shock: Which agents and when?
title_sort alternatives to norepinephrine in septic shock: which agents and when?
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9924015/
https://www.ncbi.nlm.nih.gov/pubmed/36788938
http://dx.doi.org/10.1016/j.jointm.2022.05.001
work_keys_str_mv AT jozwiakmathieu alternativestonorepinephrineinsepticshockwhichagentsandwhen