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Emergency care
Angiotensin II increases blood pressure in patients with refractory vasodilatory shock
  1. Giovanni Landoni,
  2. Alessandro Belletti
  1. Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
  1. Correspondence to Professor Giovanni Landoni, Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy; landoni.giovanni{at}

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Commentary on: Khanna A, English SW, Wang XS, et al. ATHOS-3 Investigators. Angiotensin II for the treatment of vasodilatory shock. N Engl J Med 2017;377:419–430.


Vasodilatory or distributive shock is the most common cause of shock in intensive care units (ICUs) and is characterised by low blood pressure due to peripheral vasodilation and relative hypovolaemia despite normal or increased cardiac output.1 Immediate treatment with fluids and vasopressors is required to ensure adequate organ perfusion. In several cases the desired level of mean arterial pressure (MAP) cannot be maintained despite high doses of conventional vasopressors, namely catecholamines.2 This condition is called refractory shock and is associated with a poor outcome.2 3 Several studies have investigated the effects of alternative vasopressors for treatment of vasodilatory shock.4 5 …

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  • Contributors GL and AB drafted and critically reviewed the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.