SCCM Resource Library-The New ABCs of Refractory Shock: Angiotensin II, Vitamin B12, Methylene Blue, and Vitamin C

Video Transcription

Video Summary

The video transcript discusses the use of angiotensin II and vitamin C in different contexts. The first part of the transcript focuses on angiotensin II and its role in refractory shock. It explains the molecular behavior of angiotensin II and its downstream actions, such as increasing aldosterone, sodium water retention, and afterload. The transcript highlights the significance of angiotensin II as part of a complex biofeedback mechanism for blood pressure regulation. It discusses previous studies that have shown favorable outcomes when using angiotensin II in various types of shock. The transcript also mentions the importance of the renin-angiotensin cascade and how endothelial injury can disrupt this pathway, leading to vasodilation and hypotension. It suggests that restoring the biofeedback by giving exogenous angiotensin II can help balance the system and improve outcomes. <br /><br />The second part of the transcript focuses on vitamin C and its potential use in septic shock. It discusses the biologic plausibility of vitamin C in shock and its role as an enzyme cofactor for catecholamine production and anti-inflammatory properties. The transcript reviews several studies that have explored the use of vitamin C in sepsis, including the Citrus ALI study, the Vitamins trial, and the ACT trial. It summarizes the findings of these studies, which show no significant benefits in terms of primary outcome measures like change in SOFA score or mortality. However, some studies did show potential secondary benefits, such as increased shock-free days. Finally, the transcript mentions the ongoing VICTAS trial, which aims to provide more data on the use of vitamin C in septic shock.

Asset Subtitle

Sepsis, 2021

Asset Caption

The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Learning Objectives

Identify which patients are most likely to benefit from angiotensin II
Discuss the evolving role of vitamin B12 and methylene blue in vasoplegic shock
Review the physiologic rationale of ascorbic acid for the treatment of septic shock

Pressing for New Options: Angiotensin II in Refractory Shock Ashish K. Khanna Red, Blue, or a Combination of the Two: Vitamin B12 and Methylene Blue for Refractory Shock Joel Feih Is There Still a Role for Ascorbic Acid in Septic Shock? Jonathan E. Sevransky

Meta Tag

Content Type Presentation

Knowledge Area Sepsis

Knowledge Area Shock Non Sepsis

Knowledge Level Advanced

Membership Level Select

Tag Guidelines

Tag Cardiovascular

Tag Shock

Year 2021

Keywords

angiotensin II

vitamin C

refractory shock

aldosterone

septic shock

biofeedback mechanism

endothelial injury

VICTAS trial

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