• Amar P Jadhav and Farid G Sadaka.
• Intensivist, SSM St. Mary's Hospital, Richmond Heights, St. Louis, United States of America.. Electronic address: ajadhav@soundphysicians.com.
• Am J Emerg Med. 2019 Jun 1; 37 (6): 1169-1174.

AbstractSeptic shock is a life threatening condition and a medical emergency. It is associated with organ dysfunction and hypotension despite optimal volume resuscitation. Refractory septic shock carries a very high rate of mortality and is associated with ischemic and arrhythmogenic complications from high dose vasopressors. Angiotensin II (AT-II) is a product of the renin-angiotensin-aldosterone system. It is a vasopressor agent that has been recently approved by FDA to be used in conjunction with other vasopressors (catecholamines) in refractory shock and to reduce catecholamine requirements. We have reviewed the physiology and current literature on AT-II in refractory septic/vasodilatory shock. Larger trials with longer duration of follow-up are warranted to address the questions which are unanswered by the ATHOS-3 trial, especially pertaining to its effects on lungs, brain, microcirculation, inflammation, and venous thromboembolism risk.Copyright © 2019 Elsevier Inc. All rights reserved.

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