Angiotensin II infusion and markers of organ function in invasively ventilated COVID-19 patients
| Autor: | Alberto Zangrillo, Chiara Sartini, Marina Pieri, Sergio Colombo, Maria Rosa Calvi, Giacomo Monti, Francesca Guzzo, Antonella Cipriani, Pasquale Nardelli, Rinaldo Bellomo, Giovanni Landoni, Paolo Beccaria, Alessandro Ortalda, Stefano Franchini, Ary Serpa Neto, Lorenzo Dagna, Gaetano Lombardi, Evgeny Fominskiy, Moreno Tresoldi, Marianna Sartorelli, Maria Grazia Calabrò, Andrea Assanelli, Anna Mara Scandroglio, Nicola Pasculli |
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| Přispěvatelé: | Zangrillo, A, Colombo, S, Scandroglio, Am, Fominskiy, E, Pieri, M, Calabro, Mg, Beccaria, Pf, Pasculli, N, Guzzo, F, Calvi, Mr, Cipriani, A, Sartini, C, Nardelli, P, Ortalda, A, Lombardi, G, Sartorelli, M, Monti, G, Assanelli, A, Tresoldi, M, Dagna, L, Franchini, S, Neto, A, Bellomo, R, Landoni, G |
| Rok vydání: | 2021 |
| Předmět: |
Mechanical ventilation
medicine.medical_specialty Mean arterial pressure Creatinine business.industry medicine.medical_treatment Odds ratio Angiotensin II Intensive care unit law.invention chemistry.chemical_compound Blood pressure chemistry law Internal medicine Cardiology medicine Renal replacement therapy business |
| Zdroj: | Critical Care and Resuscitation. 23:215-224 |
| ISSN: | 2652-9335 0431-8366 |
| Popis: | OBJECTIVE: The use of angiotensin II in invasively ventilated patients with coronavirus disease 2019 (COVID-19) is controversial. Its effect on organ function is unknown. DESIGN: Prospective observational study. SETTING: Intensive care unit (ICU) of a tertiary academic hospital in Milan, Italy. PARTICIPANTS: Adult patients receiving mechanical ventilation due to COVID-19. INTERVENTIONS: Use angiotensin II either as rescue vasopressor agent or as low dose vasopressor support. MAIN OUTCOME MEASURES: Patients treated before angiotensin II was available or treated in an adjacent COVID-19 ICU served as controls. For data analysis, we applied Bayesian modelling as appropriate. We assessed the effects of angiotensin II on organ function. RESULTS: We compared 46 patients receiving angiotensin II therapy with 53 controls. Compared with controls, angiotensin II increased the mean arterial pressure (median difference, 9.05 mmHg; 95% CI, 1.87–16.22; P = 0.013) and the Pao2/Fio2 ratio (median difference, 23.17; 95% CI, 3.46–42.88; P = 0.021), and decreased the odds ratio (OR) of liver dysfunction (OR, 0.32; 95% CI, 0.09–0.94). However, angiotensin II had no effect on lactate, urinary output, serum creatinine, C-reactive protein, platelet count, or thromboembolic complications. In patients with abnormal baseline serum creatinine, Bayesian modelling showed that angiotensin II carried a 95.7% probability of reducing the use of renal replacement therapy (RRT). CONCLUSIONS: In ventilated patients with COVID-19, angiotensin II therapy increased blood pressure and Pao2/Fio2 ratios, decreased the OR of liver dysfunction, and appeared to decrease the risk of RRT use in patients with abnormal baseline serum creatinine. However, all of these findings are hypothesis-generating only. TRIAL REGISTRATION: ClinicalTrials.gov NCT04318366. |
| Databáze: | OpenAIRE |
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