Administration of angiotensin II in refractory septic shock

In septic shock, hypotension is often due to peripheral vasodilation with a normal or increased cardiac output (1). In such situations, the use of vasoconstrictors to increase systemic vascular resistance may increase systemic arterial pressure and improve perfusion of the heart and other essential organs. Norepinephrine is often used in this situation for its a-adrenergic effects, but these effects often decrease with time (2). Angiotensin II is a potent vasoconstrictor whose actions are not mediated by adrenergic receptors. It has a half-life time of <2 mins. Tachyphylaxis is reportedly not a problem. The following case report describes the use of angiotensin II to increase mean arterial pressure in an adult with severe sepsis who was hypotensive despite rapid infusion rates of norepinephrine and other adrenergic drugs. We found no previous reports of the use of angiotensin II in a hemodynamically monitored patient with refractory septic shock.