Imperial College London
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Professor Anthony Gordon

Faculty of Medicine, Department of Surgery & Cancer

Chair in Anaesthesia and Critical Care
 
 
 
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Contact

 

anthony.gordon

 
 
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Location

 

ICUQueen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Russell:2020:10.1055/s-0040-1710320,
author = {Russell, JA and Gordon, AC and Williams, MD and Boyd, JH and Walley, KR and Kissoon, N},
doi = {10.1055/s-0040-1710320},
journal = {Seminars in Respiratory and Critical Care Medicine: pulmonology, critical care, allergy and immunology, infections},
pages = {59--77},
title = {Vasopressor therapy in the intensive care unit},
url = {http://dx.doi.org/10.1055/s-0040-1710320},
volume = {42},
year = {2020}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - After fluid administration for vasodilatory shock, vasopressors are commonly infused. Causes of vasodilatory shock include septic shock, post-cardiovascular surgery, post-acute myocardial infarction, postsurgery, other causes of an intense systemic inflammatory response, and drug -associated anaphylaxis. Therapeutic vasopressors are hormones that activate receptors—adrenergic: α1, α2, β1, β2; angiotensin II: AG1, AG2; vasopressin: AVPR1a, AVPR1B, AVPR2; dopamine: DA1, DA2. Vasopressor choice and dose vary widely because of patient and physician practice heterogeneity. Vasopressor adverse effects are excessive vasoconstriction causing organ ischemia/infarction, hyperglycemia, hyperlactatemia, tachycardia, and tachyarrhythmias. To date, no randomized controlled trial (RCT) of vasopressors has shown a decreased 28-day mortality rate. There is a need for evidence regarding alternative vasopressors as first-line vasopressors. We emphasize that vasopressors should be administered simultaneously with fluid replacement to prevent and decrease duration of hypotension in shock with vasodilation. Norepinephrine is the first-choice vasopressor in septic and vasodilatory shock. Interventions that decrease norepinephrine dose (vasopressin, angiotensin II) have not decreased 28-day mortality significantly. In patients not responsive to norepinephrine, vasopressin or epinephrine may be added. Angiotensin II may be useful for rapid resuscitation of profoundly hypotensive patients. Inotropic agent(s) (e.g., dobutamine) may be needed if vasopressors decrease ventricular contractility. Dopamine has fallen to almost no-use recommendation because of adverse effects; angiotensin II is available clinically; there are potent vasopressors with scant literature (e.g., methylene blue); and the novel V1a agonist selepressin missed on its pivotal RCT primary outcome. In pediatric septic shock, vasopressors, epinephrine, and norepinephrine are recommended equally becau
AU  - Russell,JA
AU  - Gordon,AC
AU  - Williams,MD
AU  - Boyd,JH
AU  - Walley,KR
AU  - Kissoon,N
DO  - 10.1055/s-0040-1710320
EP  - 77
PY  - 2020///
SN  - 1069-3424
SP  - 59
TI  - Vasopressor therapy in the intensive care unit
T2  - Seminars in Respiratory and Critical Care Medicine: pulmonology, critical care, allergy and immunology, infections
UR  - http://dx.doi.org/10.1055/s-0040-1710320
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000561069500001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0040-1710320
UR  - http://hdl.handle.net/10044/1/82615
VL  - 42
ER  -
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