Intensive Care Medicine

, Volume 36, Issue 12, pp 2019–2029

Vascular hyporesponsiveness to vasopressors in septic shock: from bench to bedside

  • B. Levy
  • S. Collin
  • N. Sennoun
  • N. Ducrocq
  • A. Kimmoun
  • P. Asfar
  • P. Perez
  • F. Meziani
Review

DOI: 10.1007/s00134-010-2045-8

Cite this article as:
Levy, B., Collin, S., Sennoun, N. et al. Intensive Care Med (2010) 36: 2019. doi:10.1007/s00134-010-2045-8

Abstract

Purpose

To delineate some of the characteristics of septic vascular hypotension, to assess the most commonly cited and reported underlying mechanisms of vascular hyporesponsiveness to vasoconstrictors in sepsis, and to briefly outline current therapeutic strategies and possible future approaches.

Methods

Source data were obtained from a PubMed search of the medical literature with the following MeSH terms: Muscle, smooth, vascular/physiopathology; hypotension/etiology; shock/physiopathology; vasodilation/physiology; shock/therapy; vasoconstrictor agents.

Results

Nitric oxide (NO) and peroxynitrite are crucial components implicated in vasoplegia and vascular hyporeactivity. Vascular ATP-sensitive and calcium-activated potassium channels are activated during shock and participate in hypotension. In addition, shock state is characterized by inappropriately low plasma glucocorticoid and vasopressin concentrations, a dysfunction and desensitization of alpha-receptors, and an inactivation of catecholamines by oxidation. Numerous other mechanisms have been individualized in animal models, the great majority of which involve NO: MEK1/2–ERK1/2 pathway, H2S, hyperglycemia, and cytoskeleton dysregulation associated with decreased actin expression.

Conclusions

Many therapeutic approaches have proven their efficiency in animal models, especially therapies directed against one particular compound, but have otherwise failed when used in human shock. Nevertheless, high doses of catecholamines, vasopressin and terlipressin, hydrocortisone, activated protein C, and non-specific shock treatment have demonstrated a partial efficiency in reversing sepsis-induced hypotension.

Keywords

Septic shock Vasopressor Nitric oxide Potassium channels Catecholamine 

Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • B. Levy
    • 1
    • 2
  • S. Collin
    • 1
  • N. Sennoun
    • 1
  • N. Ducrocq
    • 1
    • 2
  • A. Kimmoun
    • 1
    • 2
  • P. Asfar
    • 3
  • P. Perez
    • 1
  • F. Meziani
    • 4
  1. 1.Groupe Choc, Contrat Avenir INSERM 2006, Faculté de MédecineNancy UniversitéVandœuvre-lès-Nancy CedexFrance
  2. 2.Service de Réanimation Médicale, Institut du Coeur et des VaisseauxHôpitaux de Brabois, CHU de NancyVandœuvre-lès-NancyFrance
  3. 3.Laboratoire HIFIH UPRES EA 3859Université d’AngersAngersFrance
  4. 4.Laboratoire de Biophotonique et Pharmacologie, UMR 7213 CNRS, Faculté de PharmacieUniversité de StrasbourgIllkirch, StrasbourgFrance