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Rebellion in EM 2019: 3 Things That Have Changed the Way I Intubate

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miércoles, 3 de enero de 2018

Angiotensin II

PulmCrit (EMCrit)
PulmCrit - January 2, 2018 - By Josh Farkas
"...Maybe angiotensin II is a fantastic vasopressor, but currently it's doubtful whether the benefits outweigh the risks. There are several reasons that angiotensin II isn't ready for widespread use:
  1. Angiotensin II has pro-inflammatory effects, causing increased levels of interleukin-6.
  2. Angiotensin II has pro-coagulant effects, which could increase microvascular thrombosis and the risk of DVT/PE.
  3. Angiotensin II inhibition improved survival in an animal model of sepsis, suggesting that excessive angiotensin II activity can be harmful.
  4. Angiotensin II hasn't been shown to improve any outcome other than a minor increase in blood pressure. Full stop.
  5. ATHOS-3 is underpowered to detect uncommon adverse events.
  6. The rationale for using angiotensin II is very similar to the rationale for using vasopressin. Although vasopressin is occasionally quite useful, it hasn't proven to be a wonder drug."