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Cited by 197Hemodynamic Monitoring and TherapyTrauma, Hemostasis, Coagulopathy, ResuscitationSepsis Diagnosis and Treatment

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Intravenous angiotensin II for the treatment of high-output shock (ATHOS trial): a pilot study

Open access
Chawla, Lakhmir S, Busse, Laurence, Brasha-Mitchell, Ermira, Davison, Danielle, Honiq, Jacqueline, Alotaibi, Ziyad, Seneff, Michael G·2014·Critical Care
DOI 10.1186/s13054-014-0534-9PMC PMC4212099
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Abstract

Introduction: Patients with distributive shock who require high dose vasopressors have a high mortality. Angiotensin II (ATII) may prove useful in patients who remain hypotensive despite catecholamine and vasopressin therapy. The appropriate dose of parenteral angiotensin II for shock is unknown. Methods: In total, 20 patients with distributive shock and a cardiovascular Sequential Organ Failure Assessment score of 4 were randomized to either ATII infusion (N =10) or placebo (N =10) plus standard of care. ATII was started at a dose of 20 ng/kg/min, and titrated for a goal of maintaining a mean arterial pressure (MAP) of 65 mmHg. The infusion (either ATII or placebo) was continued for 6 hours then titrated off. The primary endpoint was the effect of ATII on the standing dose of norepinephrine required to maintain a MAP of 65 mmHg. Results: ATII resulted in marked reduction in norepinephrine dosing in all patients. The mean hour 1 norepinephrine dose for the placebo cohort was 27.6 ± 29.3 mcg/min versus 7.4 ± 12.4 mcg/min for the ATII cohort ( P =0.06). The most common adverse event attributable to ATII was hypertension, which occurred in 20% of patients receiving ATII. 30-day mortality for the ATII cohort and the placebo cohort was similar (50% versus 60%, P =1.00). Conclusion: Angiotensin II is an effective rescue vasopressor agent in patients with distributive shock requiring multiple vasopressors. The initial dose range of ATII that appears to be appropriate for patients with distributive shock is 2 to 10 ng/kg/min. Trial registration: Clinicaltrials.gov NCT01393782 . Registered 12 July 2011.

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Figure 1 Study drug titration protocol. NorEpi, norepinephrine; MAP, mean arterial pressure.
Figure 1 Study drug titration protocol. NorEpi, norepinephrine; MAP, mean arterial pressure.CC BY · PubMed Central
Figure 2 Patient flow diagram.
Figure 2 Patient flow diagram.CC BY · PubMed Central
Figure 3 Changes in norepinephrine dose with concurrent angiotensin II. AT-II arm, angiotensin-II arm; Angio dose, angiotensin-II dose.
Figure 3 Changes in norepinephrine dose with concurrent angiotensin II. AT-II arm, angiotensin-II arm; Angio dose, angiotensin-II dose.CC BY · PubMed Central

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Metadata

Authors
Chawla, L. S., Busse, L., Brasha-Mitchell, E., Davison, D., Honiq, J., Alotaibi, Z., & Seneff, M. G.
Affiliations
  • United States Department of Veterans Affairs (US)
  • Inova Fairfax Hospital (US)
  • Riyadh Armed Forces Hospital (SA)
Corresponding author
Chawla, Lakhmir S
ORCID
Venue
Critical Care
Publisher
Springer Science and Business Media LLC
Published
2014-10-06
Volume
18
Issue
5
Pages
534-534
ISSN
1364-8535 (ISSN-L)
DOI
10.1186/s13054-014-0534-9
PMC
PMC4212099
OpenAlex
W2031987490
Cited by
197
References
19
Citations by year
2026: 11 · 2025: 19 · 2024: 20 · 2023: 19 · 2022: 11 · 2021: 16 · 2020: 25 · 2019: 28 · 2018: 21 · 2017: 17 · 2016: 7 · 2015: 2 · 2014: 1
FWCI
8.93
Type
journal article
Language
en
Open access
Licence
Locations
  • Critical Care (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
George Washington University
Topics
  • Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Trauma, Hemostasis, Coagulopathy, Resuscitation
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
Keywords
angiotensin II, distributive shock, 30-day mortality
MeSH terms
Aged, Angiotensin II, Blood Pressure, Cardiac Output, Catecholamines, Female, Humans, Male, Middle Aged, Norepinephrine, Pilot Projects, Shock, Septic, Vasoconstrictor Agents, Treatment Outcome, Administration, Intravenous

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