Angiotensin ii therapy in refractory septic shock: which patient can benefit most? A narrative review

J Anesth Analg Crit Care. 2024 Feb 21;4(1):13. doi: 10.1186/s44158-024-00150-w.


Patients with septic shock who experience refractory hypotension despite adequate fluid resuscitation and high-dose noradrenaline have high mortality rates. To improve outcomes, evidence-based guidelines recommend starting a second vasopressor, such as vasopressin, if noradrenaline doses exceed 0.5 µg/kg/min. Recently, promising results have been observed in treating refractory hypotension with angiotensin II, which has been shown to increase mean arterial pressure and has been associated with improved outcomes. This narrative review aims to provide an overview of the pathophysiology of the renin-angiotensin system and the role of endogenous angiotensin II in vasodilatory shock with a focus on how angiotensin II treatment impacts clinical outcomes and on identifying the population that may benefit most from its use.

Keywords: Angiotensin II; Refractory shock; Septic shock; Vasopressors.

Publication types

  • Review