Two thirds of ventilated COVID-19 patients require vasopressor support . Recommended vasopressors include norepinephrine and vasopressin.
Recently, based on a randomized trial , angiotensin II (ANGII) was FDA- and EMA-approved for catecholamine-resistant vasodilatory shock.
ANGII use as primary vasopressor for vasodilatory shock has never been reported, let alone for COVID-19-associated vasodilatory shock. ANGII may be logical in this setting. It specifically assists patients recently exposed to angiotensin-converting enzyme inhibitors [2, 3] and increases the internalization and downregulation of angiotensin-converting enzyme 2 , the receptor for COVID-19.
Its use may also inform the debate about the risks and benefits of angiotensin receptor blockers in COVID-19-infected patients .
In this pilot compassionate-use case series, we used ANGII either as primary or rescue vasopressor in ventilated patients with COVID-19-associated vasodilatory shock and assessed the course of key physiological variables during the first 48 h of treatment.