ArticleCritical care (London, England)2019
Broad spectrum vasopressors: a new approach to the initial management of septic shock?
Article in Critical care (London, England), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers.
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Who cites it
25 citing papers in PubMed.
- Early multimodal vasopressor strategy in septic shock: results of the TRICYCLE randomized controlled trial.Critical care (London, England) · 2026Trial
- Resuscitative Effect of Centhaquine (LyfaquinAdvances in therapy · 2021Trial
- Clinical criteria for the definition of refractory septic shock: a joint Delphi consensus from the Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM).Intensive care medicine · 2026Article
- Comparative safety and efficacy of levosimendan versus dobutamine in acute heart failure: a systematic review, meta-analysis, and meta-regression.Annals of medicine and surgery (2012) · 2026Article
- Vasoactive-Inotropic Score Reduction Rate Is Highly Associated With Prognosis for Critically Ill Patients With Cardiogenic Shock: Insights From the Real-World Dynamic Data.Cardiovascular therapeutics · 2026Observational
- Vasoactive Agents in Burn Patients: Perspectives on Angiotensin-II.Journal of burn care & research : official publication of the American Burn Association · 2025Review
- Angiotensin II, conventional vasopressor therapy, and mortality in shock: a large, multicenter, propensity score-weighted analysis.Annals of intensive care · 2025Article
- [Vasoactive agents in septic shock-individualized strategies].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025Review
- Early multimodal vasopressor strategy in septic shock (TRICYCLE)-Study protocol for a randomized controlled clinical trial.PloS one · 2025Article
- Vasopressor Therapy.Journal of clinical medicine · 2024Review
- Impaired angiotensin II signaling in septic shock.Annals of intensive care · 2024Review
- Angiotensin ii therapy in refractory septic shock: which patient can benefit most? A narrative review.Journal of anesthesia, analgesia and critical care · 2024Review
- Precision fluid and vasoactive drug therapy for critically ill patients.Pharmacotherapy · 2023Review
- Vasopressin in Sepsis and Other Shock States: State of the Art.Journal of personalized medicine · 2023Review
- Early administration of multiple vasopressors is associated with better survival in patients with sepsis: a propensity score-weighted study.European journal of medical research · 2023Article
- Fluids and Early Vasopressors in the Management of Septic Shock: Do We Have the Right Answers Yet?Journal of critical care medicine (Universitatea de Medicina si Farmacie din Targu-Mures) · 2023Review
- Tendency of dynamic vasoactive and inotropic medications data as a robust predictor of mortality in patients with septic shock: An analysis of the MIMIC-IV database.Frontiers in cardiovascular medicine · 2023Article
- How Effective is Angiotensin II in Decreasing Mortality of Vasodilatory Shock? A Systematic Review.Open access emergency medicine : OAEM · 2023Review
- A plea for personalization of the hemodynamic management of septic shock.Critical care (London, England) · 2022Review
- Angiotensin II - A Brief Review and Role in Severe SARS-COV-2 Sepsis.Journal of cardiothoracic and vascular anesthesia · 2022Review
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The mainstay of hemodynamic treatment of septic shock is fluid resuscitation followed by vasopressors where fluids alone are insufficient to achieve target blood pressure. Norepinephrine, a catecholamine, is the first-line vasopressor used worldwide but given that all routinely used catecholamines target the same adrenergic receptors, many clinicians may add a non-catecholamine vasopressor where refractory hypotension due to septic shock is present. However, the timing of this additional intervention is variable. This decision is based on three key factors: availability, familiarity, and safety profile. In our opinion, further consideration should be potential vasopressor response because following appropriate volume resuscitation, the response to different vasopressor classes is neither uniform nor predictable. Critically ill patients who are non-responders to high-dose catecholamines have a dismal outcome. Similarly, patients have a variable response to non-catecholamine agents including vasopressin and angiotensin II: but where patients exhibit a blood pressure response the outcomes are improved over non-responders. This variable responsiveness to vasopressors is similar to the clinical approach of anti-microbial sensitivity. In this commentary, the authors propose the concept of "broad spectrum vasopressors" wherein patients with septic shock are started on multiple vasopressors with a different mechanism of action simultaneously while the vasopressor sensitivity is assessed. Once the vasopressor sensitivities are assessed, then the vasopressors are 'de-escalated' accordingly. We believe that this concept may offer a new approach to the treatment of septic shock.
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