Angiotensin II Stress Test. Renin Kinetics During Treatment of Vasoplegic Shock With Angiotensin II.

In patients with distributive shock (≥18 years) with noradrenaline >0,3 mcg/kg/min and vasopressin >0,03 IE/min not achieving an appropriate mean arterial pressure (65-85 mmHg) an angiotensin II infusion will be started at 20 ng/kg/min and after that adjusted to a max dose of 40 ng/kg/min if needed. Before the infusion and 6 hours after the start of angiotensin II infusion a blood sample will be drawn to determine the renin concentration. The primary outcome will be organ failure free days and ICU free days. Secondary outcome will be the need for vasopressors, dialysis, mechanical ventilation, trend of renin concentration.

Inclusion criteria

• patients with distributive shock lasting < 72 hours
• a goal mean arterial pressure (65-85 mmHg) not achieved despite an infusion of at least noradrenaline 0.3 mcg/kg/min and vasopressin 0.03 IE/min
• the patient did not get angiotensin II before
• predicted survival is >24h
• no limitations for active treatment

Exclusion criteria

• burns >20% body area
• acute coronary syndrome
• bronchospasm
• liver disease (MELD ≥30)
• severe acute bleeding (need for 4 or more units of concentrated erythrocyte)
• acute mesenteric ischemia
• aortic dissection
• leucopenia <1000/mm3
• pregnancy
• Raynaud disease, systemic sclerosis, vasospastic disease
• the need for daily dose of hydrocortisone 500 mg or more
• ECMO