Angiotensin II infusion in COVID-19-associated vasodilatory shock: a case series

Excerpt

Two thirds of ventilated COVID-19 patients require vasopressor support [1]. Recommended vasopressors include norepinephrine and vasopressin. Recently, based on a randomized trial [2], angiotensin II (ANGII) was FDA- and EMA-approved for catecholamine-resistant vasodilatory shock. ANGII use as primary vasopressor for vasodilatory shock has never been reported, let alone for COVID-19-associated vasodilatory shock. ANGII may be logical in this setting. It specifically assists patients recently exposed to angiotensin-converting enzyme inhibitors [2, 3] and increases the internalization and downregulation of angiotensin-converting enzyme 2 [4], the receptor for COVID-19. Its use may also inform the debate about the risks and benefits of angiotensin receptor blockers in COVID-19-infected patients [5]. In this pilot compassionate-use case series, we used ANGII either as primary or rescue vasopressor in ventilated patients with COVID-19-associated vasodilatory shock and assessed the course of key physiological variables during the first 48 h of treatment. …