Book review
https://doi.org/10.3325/cmj.2023.64.20 1
Intravenous infusion of angiotensin II for treatment of cardiopulmonary bypassinduced vasoplegic shock after implantation of left ventricular assist device: a case report
Andrej Šribar
; Clinical Department of Anesthesiology, Reanimatology and Intensive Care Medicine Dubrava University Hospital, Zagreb, Croatia
Verica Mikecin
; Clinical Department of Anesthesiology, Reanimatology and Intensive Care Medicine Dubrava University Hospital, Zagreb, Croatia
Ivana Presečki
; Clinical Department of Anesthesiology, Reanimatology and Intensive Care Medicine Dubrava University Hospital, Zagreb, Croatia
Davor Barić
; Department of Cardiac Surgery, Dubrava University Hospital, Zagreb, Croatia
Domagoj Marijančević
; Clinical Department of Laboratory Diagnostics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
Jasminka Peršec
orcid.org/0000-0002-3777-8153
; Clinical Department of Anesthesiology, Reanimatology and Intensive Care Medicine Dubrava University Hospital, Zagreb, Croatia
*
* Corresponding author.
Abstract
We report on the first successful treatment of severe phar
-
macoresistant vasoplegic syndrome with angiotensin II
acetate (ATII) in Croatia. ATII is a novel drug used to treat
severe vasoplegic shock resistant to the administration of
catecholamines or alternative vasopressors such as vaso
-
pressin or methylene blue. A 44-year-old patient with sec
-
ondary toxic cardiomyopathy developed severe cardiopul
-
monary bypass-induced vasoplegic shock after scheduled
implantation of a left-ventricular assist device. The cardiac
output was maintained, but systemic vascular resistance
(SVR) was extremely low. The patient had an inadequate
reaction to the administration of high doses of norepine
-
phrine (up to 0.7 µg/kg/min) and vasopressin (0.03 IU/
min). At postoperative intensive care unit (ICU) admission,
serum renin levels were unmeasurably high (>330 ng/L),
and infusion of ATII 20 ng/kg/min was initiated. Soon after the start of the infusion, blood pressure increased. Vasopressin infusion was stopped, while the norepinephrine
dose was decreased from 0.7 to 0.15 µg/kg/min. Serum
lactate, mixed venous saturation, and glomerular filtra
-
tion rate markedly improved. The patient was extubated
16 h after the ICU admission. Twenty-four hours after the
start of the ATII infusion, serum renin dropped to 255 ng/L,
and laboratory findings further improved. On postopera
-
tive day 3, the norepinephrine infusion was stopped. On
day 6, renin further dropped to 136 ng/L, and the patient
was hemodynamically stable and discharged from the ICU.
In conclusion, ATII favorably affected the patient’s vascular
tone, enabling rapid hemodynamic stabilization and short
-
ening the ICU and hospital sta
Keywords
Hrčak ID:
331540
URI
Publication date:
30.6.2023.
Visits: 292 *