David Ragoonanan, PharmD, BCCCP,
Critical Care Pharmacist
SARASOTA MEMORIAL HOSPITAL
Sarasota, Florida
Disclosure information not submitted.
Maresa Glass, PharmD, BCCCP,FCCM
Pharmacotherapy Specialist Coordinator- Critical Care
Tampa General Hospital, United States
Disclosure information not submitted.
Kevin Ferguson, PharmD, BCPS, BCCCP
Critical Care Pharmacist
Tampa General Hospital, United States
Disclosure information not submitted.
Veeshal Modi, MD
Critical Care Attending Physician
Tampa General Hospital, United States
Disclosure information not submitted.
Kristen Zeitler, PharmD, BCPS
Infectious Disease Pharmacist
Tampa General Hospital, United States
Disclosure information not submitted.
Title: Angiotensin II for the Treatment of Refractory Septic Shock (AFTERSHOCK)
Introduction: Catecholamine-refractory shock is associated with high mortality. Angiotensin II has been proposed as an alternative agent due to its unique mechanism of action. Multiple studies have shown hemodynamic benefits with angiotensin II initiation in catecholamine-resistant shock. However, the effects of angiotensin II on vasopressor duration have not been adequately assessed. The purpose of this study was to evaluate the impact of angiotensin II in patients with refractory septic shock.
Methods: This was a single-centered, retrospective, before-after cohort. The outcomes and clinical course of septic patients in the "AT-II" group receiving angiotensin II from September 1, 2020 to February 28, 2021 were compared with the "non-AT-II" group not receiving angiotensin II during the preceding months from January 1, 2019 to August 31, 2020. Adults diagnosed with septic shock receiving > 0.2 mcg/kg/min norepinephrine equivalent doses (NED) and broad-spectrum antibiotics were evaluated. The primary outcome was time to vasopressor discontinuation. Secondary outcomes included mean change in SOFA score at 48 hours, ICU length of stay (LOS), in-hospital mortality, need for renal replacement therapy, number of vasopressors, and incidence of venous thromboembolism at 30 days.
Results: A total of 52 patients were identified for inclusion in this cohort: 17 subjects in the AT-II group and 35 subjects in the non-AT-II group. Baseline characteristics were similar between the groups. There was no significant difference in the primary outcome between the AT-II group vs non-AT-II group (HR, 0.99; 95% CI, 0.55-1.79; p=0.984). Furthermore, no significant differences in secondary outcomes were observed between the groups.
Conclusions: In this single-centered, retrospective, before-after study, addition of AT-II did not result in shorter time to vasopressor discontinuation. Further analysis with a larger sample size and earlier initiation of angiotensin II is warranted.