Septic Shock Clinical Trial
Official title:
Angiotensin II for Septic Shock Treatment: Effects On Macro- and Microcirculation A Randomized, Controlled Pilot Trial (ANGSTROM Trial)
This study aims to investigate the effect of angiotensin II on microcirculation and peripheral perfusion in patients with septic shock.
Shock is a syndrome characterized by acute circulatory failure resulting in impaired
peripheral tissue perfusion. Distributive shock is the most common type of shock and is
usually caused by severe sepsis. Distributive shock is characterized by profound
vasodilatation leading to decreased arterial blood pressure and impaired organ perfusion
despite high cardiac output.
The use of vasopressors is an essential management line for distributive sock. Two groups of
vasopressors are usually used for management of shock: catecholamines and vasopressin-like
peptides. There is a continuous need for other vasopressors because:
1- Available vasopressors have narrow therapeutic window. 2- Patients with severe hypotension
refractory to the currently available classes usually die.
A third system is usually engaged in the physiology of shock which is
Renin-Angiotensin—aldosterone system. Angiotensin II is a natural hormone which is a potent
vasopressor; moreover, angiotensin II stimulates the production of both antidiuretic hormone
and adrenocorticotropin hormone.
In a pilot study, angiotensin II was reported as an effective rescue vasopressor in septic
shock patients on multiple vasopressors. Angiotensin II improved mean arterial pressure and
helped in reduction of the doses of catecholamines. In a recent large randomized controlled
trial, angiotensin II improved blood pressure in catecholamine-resistant distributive shock
patients.
Microcirculation is the primary site of oxygen and nutrient exchange. Maintenance of
microcirculatory perfusion is a prerequisite for preservation of organ function. Multiple
organ failure is common in patients with distributive shock despite maintenance of parameters
of global perfusion due to disrupted microcirculatory perfusion. Furthermore, restoration of
microcirculatory perfusion was correlated with improvement in survival. This study aims to
investigate the effect of angiotensin II on peripheral microcirculation in patients with
septic shock.
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