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Reversal of Vasodilatory Shock

Current Perspectives on Conventional, Rescue, and Emerging Vasoactive Agents for the Treatment of Shock

Chow, Jonathan H. MD*; Abuelkasem, Ezeldeen MBBCh, MSc; Sankova, Susan MD*; Henderson, Reney A. MD*; Mazzeffi, Michael A. MD, MPH*; Tanaka, Kenichi A. MD, MSc*

doi: 10.1213/ANE.0000000000004343
Anesthetic Clinical Pharmacology: PDF Only

Understanding the different mechanisms of vasoconstrictors is crucial to their optimal application to clinically diverse shock states. We present a comprehensive review of conventional, rescue, and novel vasoactive agents including their pharmacology and evidence supporting their use in vasodilatory shock. The role of each drug in relation to the Surviving Sepsis Guidelines is discussed to provide a context of how each one fits into the algorithm for treating vasodilatory shock. Rescue agents can be utilized when conventional medications fail, although there are varying levels of evidence on their clinical effectiveness. In addition, novel agents for the treatment of vasodilatory shock have recently emerged such as ascorbic acid and angiotensin II. Ascorbic acid has been used with some success in vasoplegia and is currently undergoing a more rigorous evaluation of its utility. Angiotensin II (Ang-2) is the newest available vasopressor for the treatment of vasodilatory shock. In addition to its catecholamine-sparing properties, it has been shown to hold promising mortality benefits in certain subsets of critically ill patients.

From the *Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland

Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Accepted for publication June 17, 2019.

Funding: None.

Conflicts of Interest: See Disclosures at the end of the article.

Reprints will not be available from the authors.

Address correspondence to Jonathan H. Chow, MD, Department of Anesthesiology, Division of Critical Care Medicine, University of Maryland School of Medicine, 22 S Greene St, Suite S11D20, Baltimore, MD 21201. Address e-mail to

© 2019 International Anesthesia Research Society
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