CHEST 2023 On Demand Pass-Vasoactive Therapies in Refractory Septic Shock

Video Transcription

Video Summary

The video discusses the use of lesser-used agents for refractory shock, specifically focusing on angiotensin II and epinephrine. The speaker discusses the pathophysiology of the renin-angiotensin system and how angiotensin II affects vasodilation and vasoconstriction. The speaker then presents the evidence for the use of angiotensin II in refractory shock, highlighting the ATAC-3 trial which showed that angiotensin II effectively increased blood pressure in patients with refractory vasodilatory shock. The speaker also discusses other studies that suggest that patients with higher renin levels or high angiotensin 1 to angiotensin 2 ratio may respond better to angiotensin II therapy. The video then shifts to discussing the use of epinephrine as a third-line vasopressor in refractory shock. The speaker acknowledges that there is no consensus on when to use epinephrine, but highlights a study that showed higher mortality in patients receiving epinephrine or dopamine as third-line vasopressors. The speaker also discusses a study that compared epinephrine to norepinephrine in the setting of cardiogenic shock and found no difference in outcomes. The speaker emphasizes the need to individualize treatment based on the patient's shock profile, including echocardiographic assessment of cardiac function and determining if LV function is adequate. The speaker suggests that in these patients, increasing the vasopressin dose or adding angiotensin II may be more effective than adding epinephrine or dopamine. However, the speaker also highlights the lack of consensus and the need for further research in this area.

Meta Tag

Category Critical Care

Session ID 1133

Speaker Seth Bauer

Speaker Zainab Gandhi

Speaker Gretchen Sacha

Speaker Ryota Sato

Track Critical Care

Keywords

refractory shock

angiotensin II

epinephrine

renin-angiotensin system

ATAC-3 trial

vasodilatory shock

mortality

cardiogenic shock

echocardiographic assessment