Trial reportCritical care (London, England)2014
Intravenous angiotensin II for the treatment of high-output shock (ATHOS trial): a pilot study.
Trial report in Critical care (London, England), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 4 registered trials, which are not on this map. Cited by 70 papers, 7 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Intravenous AII for the Treatment of Severe Hypotension in High Output Shock: A Pilot Study
A Dose Finding Trial for Angiotensin II in Hypertensive Adults on Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers With Anesthesia-Mediated Hypotension
Angiotensin II Stress Test. Renin Kinetics During Treatment of Vasoplegic Shock With Angiotensin II in Relation to Hemodynamic Response to Treatment With Angiotensin II.
ANGIOtensin II for Septic Shock in the Emergency Department: ANGIO-ED Study
Who cites it
70 citing papers in PubMed, 7 syntheses or guidelines pooled it, 197 citations in OpenAlex.
- Surviving Sepsis Campaign International Guidelines for the Management of Sepsis and Septic Shock in Children 2026.Intensive care medicine · 2026Pooled it
- An overview of reviews of Angiotensin II in distributive shock.BMC anesthesiology · 2026Pooled it
- The effects of vasopressor choice on renal outcomes in septic shock: a systematic review of randomised trials as a guide for future research.Critical care (London, England) · 2025Pooled it
- ADJUNCTIVE VASOPRESSORS AND SHORT-TERM MORTALITY IN ADULTS WITH SEPTIC SHOCK: A SYSTEMATIC REVIEW AND META-ANALYSIS.Shock (Augusta, Ga.) · 2025Pooled it
- Non-adrenergic vasopressors for vasodilatory shock or perioperative vasoplegia: a meta-analysis of randomized controlled trials.Critical care (London, England) · 2024Pooled it
- Clinical Experience With IV Angiotensin II Administration: A Systematic Review of Safety.Critical care medicine · 2017Pooled it
- Vasopressors for hypotensive shock.The Cochrane database of systematic reviews · 2016Pooled it
- A Pilot, Single-Blinded, Randomized Crossover Trial of Cramp Reduction with Angiotensin II in Maintenance Patients on Hemodialysis (the CRAMP-HD Study).American journal of nephrology · 2025Trial
- Renin and Survival in Patients Given Angiotensin II for Catecholamine-Resistant Vasodilatory Shock. A Clinical Trial.American journal of respiratory and critical care medicine · 2020Trial
- Update on sepsis treatment.Journal of intensive care · 2026Review
- Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026.Intensive care medicine · 2026Article
- Vasoactive Agents in Burn Patients: Perspectives on Angiotensin-II.Journal of burn care & research : official publication of the American Burn Association · 2025Review
- Article
- Kinetics of Renin Concentrations in Infants Undergoing Congenital Cardiac Surgery.Journal of intensive care medicine · 2025Article
- Early multimodal vasopressor strategy in septic shock (TRICYCLE)-Study protocol for a randomized controlled clinical trial.PloS one · 2025Article
- New drugs for acute kidney injury.Journal of intensive medicine · 2025Review
- Haemodynamic management of septic shock.Burns & trauma · 2025Review
- [What is confirmed in the treatment of sepsis? : An update].Innere Medizin (Heidelberg, Germany) · 2024Review
- Angiotensin II-Real-Life Use and Literature Review.Medicina (Kaunas, Lithuania) · 2024Review
- Clinical Outcomes of Angiotensin II Therapy in Vasoplegic Shock: A Systematic Review and Meta-Analysis.Life (Basel, Switzerland) · 2024Review
10 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionPatients with distributive shock who require high dose vasopressors have a high mortality. Angiotensin II (ATII) may prove useful in patients who remain hypotensive despite catecholamine and vasopressin therapy. The appropriate dose of parenteral angiotensin II for shock is unknown.
methodsIn total, 20 patients with distributive shock and a cardiovascular Sequential Organ Failure Assessment score of 4 were randomized to either ATII infusion (N =10) or placebo (N =10) plus standard of care. ATII was started at a dose of 20 ng/kg/min, and titrated for a goal of maintaining a mean arterial pressure (MAP) of 65 mmHg. The infusion (either ATII or placebo) was continued for 6 hours then titrated off. The primary endpoint was the effect of ATII on the standing dose of norepinephrine required to maintain a MAP of 65 mmHg.
resultsATII resulted in marked reduction in norepinephrine dosing in all patients. The mean hour 1 norepinephrine dose for the placebo cohort was 27.6 ± 29.3 mcg/min versus 7.4 ± 12.4 mcg/min for the ATII cohort (P =0.06). The most common adverse event attributable to ATII was hypertension, which occurred in 20% of patients receiving ATII. 30-day mortality for the ATII cohort and the placebo cohort was similar (50% versus 60%, P =1.00).
conclusionAngiotensin II is an effective rescue vasopressor agent in patients with distributive shock requiring multiple vasopressors. The initial dose range of ATII that appears to be appropriate for patients with distributive shock is 2 to 10 ng/kg/min.
trial registrationClinicaltrials.gov NCT01393782. Registered 12 July 2011.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.