Angiotensin II treatment is associated with improved oxygenation in ARDS patients with refractory vasodilatory shock.
Ann Intensive Care
; 13(1): 128, 2023 Dec 16.
Article
em En
| MEDLINE
| ID: mdl-38103056
ABSTRACT
BACKGROUND:
The physiological effects of renin-angiotensin system modulation in acute respiratory distress syndrome (ARDS) remain controversial and have not been investigated in randomized trials. We sought to determine whether angiotensin-II treatment is associated with improved oxygenation in shock-associated ARDS.METHODS:
Post-hoc subgroup analysis of the Angiotensin Therapy for High Output Shock (ATHOS-3) trial. We studied patients who met modified Berlin ARDS criteria at enrollment. The primary outcome was PaO2/FiO2-ratio (PF) at 48-h adjusted for baseline PF. Secondary outcomes included oxygenation index, ventilatory ratio, PEEP, minute-ventilation, hemodynamic measures, patients alive and ventilator-free by day-7, and mortality.RESULTS:
Of 81 ARDS patients, 34 (42%) and 47 (58%) were randomized to angiotensin-II or placebo, respectively. In angiotensin-II patients, mean PF increased from 155 mmHg (SD 69) at baseline to 265 mmHg (SD 160) at hour-48 compared with no change with placebo (148 mmHg (SD 63) at baseline versus 164 mmHg (SD 74) at hour-48)(baseline-adjusted difference + 98.4 mmHg [95%CI 35.2-161.5], p = 0.0028). Similarly, oxygenation index decreased by - 6.0 cmH2O/mmHg at hour-48 with angiotensin-II versus - 0.4 cmH2O/mmHg with placebo (baseline-adjusted difference -4.8 cmH2O/mmHg, [95%CI - 8.6 to - 1.1], p = 0.0273). There was no difference in PEEP, minute ventilation, or ventilatory ratio. Twenty-two (64.7%) angiotensin-II patients had sustained hemodynamic response to treatment at hour-3 versus 17 (36.2%) placebo patients (absolute risk-difference 28.5% [95%CI 6.5-47.0%], p = 0.0120). At day-7, 7/34 (20.6%) angiotensin-II patients were alive and ventilator-free versus 5/47(10.6%) placebo patients. Day-28 mortality was 55.9% in the angiotensin-II group versus 68.1% in the placebo group.CONCLUSIONS:
In post-hoc analysis of the ATHOS-3 trial, angiotensin-II was associated with improved oxygenation versus placebo among patients with ARDS and catecholamine-refractory vasodilatory shock. These findings provide a physiologic rationale for trials of angiotensin-II as treatment for ARDS with vasodilatory shock. TRIAL REGISTRATION ClinicalTrials.Gov Identifier NCT02338843 (Registered January 14th 2015).
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Coleções:
01-internacional
Base de dados:
MEDLINE
Idioma:
En
Revista:
Ann Intensive Care
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Estados Unidos