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Angiotensin II infusion and markers of organ function in invasively ventilated COVID-19 patients
Critical Care and Resuscitation ; 23(2):215-224, 2021.
Article in English | Web of Science | ID: covidwho-1283185
ABSTRACT

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/FiO(2) 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/FiO(2) 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.
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Collection: Databases of international organizations Database: Web of Science Language: English Journal: Critical Care and Resuscitation Year: 2021 Document Type: Article

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Collection: Databases of international organizations Database: Web of Science Language: English Journal: Critical Care and Resuscitation Year: 2021 Document Type: Article