Cleveland Clinic Anesthesiologist makes the news.

[ProRealDoc]

https://newsroom.clevelandclinic.or...g-critically-ill-patients-low-blood-pressure/

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[Laryngophed]

I think what they are driving at is that in a patient with shock, if you augment the body's response to shock with anti-shock interventions, the patient has less shock?

 

[Consigliere]

"The study enrolled 321 patients – 163 treated with angiotensin II and 158 with placebo – who were experiencing vasodilatory shock and had received high doses of conventional vasopressors."

Damn. Would have hated to have been in the placebo group.

 

[waterbottle10]

Question is does it imrpove mortality. If they are shocking away on epi levo vaso. Will adding a 4th help the patient get better or just postpone death and prolong ICU stay?

 

[teeva]

Quote from link:

“Vasodilatory shock – in which a patient’s blood pressure drops and blood vessels dilate – is a serious concern for ICU patients. When the condition is not responsive to high-dose vasopressors like norepinephrine and vasopressin, it is associated with high mortality, with more than half of these patients dying within 30 days,” Dr. Khanna said. “We found that angiotensin II is an effective intervention for these patients, significantly increasing blood pressure in this life-threatening situation. The drug was safe and well-tolerated and also showed a trend to decreased mortality, though this did not achieve clinical significance.”

 

[waterbottle10]

So instead of getting 28 day ICU stays before death now it will be 32 days before death...

 

[narcusprince]

Getum Ashish! Good guy in my book!

 

[waterbottle10]

Still exponentially more than what you or anyone else here will ever contribute to this world.

I doubt it.

Either way I'm just saying that some of these studies need to use more than just mortality in 30 days . how much does mortality at 30 says mean to someone on 3 pressors and need a 4th. But obviously will need to read the paper. Might have more content

 

[pgg]

Question is does it imrpove mortality. If they are shocking away on epi levo vaso. Will adding a 4th help the patient get better or just postpone death and prolong ICU stay?

"showed a trend to decreased mortality, though this did not achieve clinical significance"

"our trial was not powered to detect mortality effects"

An international multicenter prospective randomized placebo controlled double blinded trial is a lot of trouble to go to if you can't power it to measure the only important outcome. But I'll temper my normal rock-chucking tendencies.


They used CVP as part of their shock definition? That's odd, but whatever.

Primary end point: MAP response to >75 from in 3 hours, p .001. Yep, it's a better vasopressor than placebo.

Secondary end point: decrease in SOFA score, p .01. But the SOFA score incorporates vasopressor dose, and angiotensin II isn't on the list. Substitute that for a vasopressor on the list, and wow, you've reduced the SOFA score.

Looks like they've probably established that the stuff isn't more harmful than conventional therapy.

 

[pgg]

Still exponentially more than what you or anyone else here will ever contribute to this world.

Don't those of us who aren't doing international multicenter prospective randomized placebo controlled double blinded trials still get to read them with a critical / skeptical eye?

 

[waterbottle10]

I feel like the vast majority of my deaths on the icu have been due to withdrawal of care. Besides that it's not that difficult postponing people's deaths. People that do die tend to be slow deaths that ultimately result in comfort care/withdrawal.

 

[BLADEMDA]

As you may know I'm a big proponent of Vasopressin in near death situations of all kinds. So, I think the use of Angiotensin II is definitely worth exploring as a means of reversing life-threatening hypotension due to sepsis.

Dr. Khanna's research could be of great value to us in the near future. I appreciate the OP posting this thread and I look forward to reading more articles about the usefulness of Angiotensin II in clinical care.

Perhaps, Angiotensin II belongs on my list of emergency drugs like low dose Epi and Vasopressin:

Dr. Khanna said. “We found that angiotensin II is an effective intervention for these patients, significantly increasing blood pressure in this life-threatening situation. The drug was safe and well-tolerated and also showed a trend to decreased mortality, though this did not achieve clinical significance.”

 

[anbuitachi]

As you may know I'm a big proponent of Vasopressin in near death situations of all kinds. So, I think the use of Angiotensin II is definitely worth exploring as a means of reversing life-threatening hypotension due to sepsis.

Dr. Khanna's research could be of great value to us in the near future. I appreciate the OP posting this thread and I look forward to reading more articles about the usefulness of Angiotensin II in clinical care.

Perhaps, Angiotensin II belongs on my list of emergency drugs like low dose Epi and Vasopressin:

Dr. Khanna said. “We found that angiotensin II is an effective intervention for these patients, significantly increasing blood pressure in this life-threatening situation. The drug was safe and well-tolerated and also showed a trend to decreased mortality, though this did not achieve clinical significance.”

Definitely good to have another pressor other than dopamine

 

[Ronin786]

Old news:

http://gomerblog.com/2015/12/5th-pressor/

 

[Psai]

Man so a drug that is known to raise blood pressure for decades raises blood pressure. No effect on mortality. This is nejm worthy and it only took 75 icus to come up with this.

 

[deleted171991]

Man so a drug that is known to raise blood pressure for decades raises blood pressure. No effect on mortality. This is nejm worthy and it only took 75 icus to come up with this.

Bingo! I couldn't believe that this got published myself.

 

[anbuitachi]

prob got some major connections

 

[nimbus]

So A2 or vitC or both?

 

[deleted171991]

So A2 or vitC or both?

Vitamin C. That one has a much more convincing study behind it.

Angiotensin II is just another (probably pricey) pressor, with zero proof that it helps more than the usual ones. The only thing the paper proves, beyond any doubt, is that angiotensin is a better pressor than saline (placebo). Amazing, unheard of!

 

[Noyac]

I think what they are driving at is that in a patient with shock, if you augment the body's response to shock with anti-shock interventions, the patient has less shock?

That's a bold statement!

 

[wickedskillz]

If it get's approved as a 4th pressor, the interesting question will be if it can be used as a first line-pressor, and will it's side effect profile make it more beneficial in some patients than our current pressors, or it it will have any other positive effects (like decreasing edema, etc)

 

[Planktonmd]

"The study enrolled 321 patients – 163 treated with angiotensin II and 158 with placebo – who were experiencing vasodilatory shock and had received high doses of conventional vasopressors."

Damn. Would have hated to have been in the placebo group.

I think the placebo group and the angiotensin group had both received the conventional medications (norepi, vaso) and reached high doses before they were enrolled in the study.