Multimodal strategy to counteract vasodilation in septic shock.

Abstract

Early initiation of a multimodal treatment strategy in the management of vasopressors during septic shock has been advocated to reduce delays in restoring adequate organ perfusion and to mitigate side effects associated with the administration of high-dose catecholamines. We provide a review that summarises the pathophysiology of vasodilation, the physiologic response to the vascular response, and the different drugs used in this situation, focusing on the need to combine early different vasopressors. Fluid loading being insufficient for counteracting vasoplegia, norepinephrine is usually the first-line vasopressor used to restore hemodynamics. Norepinephrine sparing is discussed in further detail through the concomitant use of adrenergic, vasopressinergic, and renin-angiotensin systems and the optimisation of endothelial reactivity with methylene blue. A blueprint for the construction of new studies is outlined to address the question of vasopressor selection and timing in septic shock.

• Authors: Marc Leone, Sharon Einav, Elio Antonucci, François Depret, Ines Lakbar, Ignacio Martin-Loeches, Patrick M Wieruszewski, Sheila Nainan Myatra, Ashish K Khanna
• Journal: Anaesthesia, critical care & pain medicine (Anaesth Crit Care Pain Med) Vol. 42 Issue 3 Pg. 101193 (06 2023) ISSN: 2352-5568 [Electronic] France
• PMID: 36621622 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2023 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

Chemical References

• Norepinephrine
• Vasoconstrictor Agents
• Catecholamines

Topics

• Humans
• Shock, Septic (drug therapy)
• Vasodilation
• Norepinephrine (therapeutic use)
• Vasoconstrictor Agents (therapeutic use)
• Catecholamines (therapeutic use)
• Hypotension (chemically induced)
• Shock