Vasoactive drugs in vasodilatory shock, Anupdate
Keywords:
septic shock, vasopressors, vasoactive agents, catecholamines, vasoplegiaAbstract
Vasodilator or vasoplegic shock associated with sepsis (septic shock) is the most common hemodynamic disorder in intensive care units, and one of the main causes of morbidity and mortality. The objective of this paper is to update the management with vasoactive drugs in vasoplegic shock, based on the most current trends, of a subject in which the evidence regarding its therapeutic management is not conclusive and requires further investigation. an individualized therapeutic strategy. Treatment strategies involve its rapid identification and the establishment of measures aimed at correcting the hemodynamic disorder, focused on the mechanisms involved in the pathophysiology. The pillars of treatment are the correction of its cause, the timely supply of fluids, and vasoactive drugs. The most recent reviews recommend the early use of vasopressors, concomitantly with fluids, focused on achieving faster responses, with shorter hypotension time to prevent the deleterious effects of volume supply in unnecessary amounts, and the use of vasoactive drugs in combination, in order to avoid harmful effects derived from the use of high doses of these drugs. In light of current knowledge, therapy directed at the pathophysiological substrate (hypovolemia, vasodilatation, cardiomyopathy) and guided by the identification of biomarkers such as determinations of nitric oxide, vasopressin, renin or angiotensin-II levels, would allow a more efficient treatment. individualized of this type of disorder.
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