Hemodynamic Impact of Vasopressor Therapy in Critically Ill Patients with Septic Shock in the Intensive Care Unit
DOI:
https://doi.org/10.64784/224Palabras clave:
Septic shock, vasopressor therapy, norepinephrine, vasopressin, angiotensin II, hemodynamic stabilization, intensive care unit, critical care medicine, tissue perfusion, mean arterial pressure, organ dysfunction, vasoactive agents, sepsis, hemodynamic monitoring, AmericasResumen
Septic shock remains one of the leading causes of mortality among critically ill patients admitted to intensive care units worldwide. Profound vasodilation, circulatory dysfunction, and impaired tissue perfusion frequently necessitate the use of vasopressor therapy to restore hemodynamic stability and preserve organ function. This review analyzes the current evidence regarding the hemodynamic impact of vasopressor therapy in adult patients with septic shock, with particular emphasis on clinical experiences and healthcare systems across the American continent. Scientific literature from major biomedical databases was examined to evaluate the physiological effects, therapeutic efficacy, safety profiles, and clinical outcomes associated with commonly used vasoactive agents, including norepinephrine, vasopressin, epinephrine, dopamine, phenylephrine, and angiotensin II. The findings indicate that norepinephrine remains the preferred first-line vasopressor due to its favorable balance between efficacy and safety. Early vasopressor initiation was consistently associated with improved hemodynamic stabilization, reduced duration of hypotension, and enhanced tissue perfusion. Adjunctive therapies such as vasopressin and angiotensin II demonstrated potential benefits in selected patients with refractory vasodilatory shock. The review also highlights the importance of individualized blood pressure targets, integration of microcirculatory assessment, and adherence to evidence-based sepsis protocols. Furthermore, regional differences in critical care resources, medication availability, and healthcare infrastructure were identified as important factors influencing outcomes throughout the Americas. The available evidence supports the implementation of personalized vasopressor strategies combined with comprehensive critical care management to improve survival and reduce organ dysfunction in patients with septic shock.
Referencias
• Annane, D., Vignon, P., Renault, A., Bollaert, P. E., Charpentier, C., Martin, C., Troché, G., Ricard, J. D., Nitenberg, G., Papazian, L., Azoulay, E., Bellissant, E., & CATS Study Group. (2007). Norepinephrine plus dobutamine versus epinephrine alone for management of septic shock: A randomised trial. The Lancet, 370(9588), 676–684. https://doi.org/10.1016/S0140-6736(07)61344-0
• Asfar, P., Meziani, F., Hamel, J. F., Grelon, F., Megarbane, B., Anguel, N., Mira, J. P., Dequin, P. F., Gergaud, S., Weiss, N., Legay, F., Le Tulzo, Y., Conrad, M., Robert, R., Gonzalez, F., Guitton, C., Tamion, F., Tonnelier, J. M., Guezennec, P., … SEPSISPAM Investigators. (2014). High versus low blood-pressure target in patients with septic shock. The New England Journal of Medicine, 370(17), 1583–1593. https://doi.org/10.1056/NEJMoa1312173
• Avni, T., Lador, A., Lev, S., Leibovici, L., Paul, M., & Grossman, A. (2015). Vasopressors for the treatment of septic shock: Systematic review and meta-analysis. PLoS ONE, 10(8), e0129305. https://doi.org/10.1371/journal.pone.0129305
• Cheng, L., Yan, J., Han, S., Chen, Q., Liu, J., & Li, Y. (2019). Comparative efficacy of vasoactive medications in patients with septic shock: A network meta-analysis of randomized controlled trials. Critical Care, 23, 168. https://doi.org/10.1186/s13054-019-2427-4
• De Backer, D., Biston, P., Devriendt, J., Madl, C., Chochrad, D., Aldecoa, C., Brasseur, A., Defrance, P., Gottignies, P., Vincent, J. L., & SOAP II Investigators. (2010). Comparison of dopamine and norepinephrine in the treatment of shock. The New England Journal of Medicine, 362(9), 779–789. https://doi.org/10.1056/NEJMoa0907118
• Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., McIntyre, L., Ostermann, M., Prescott, H. C., Schorr, C., Simpson, S., Wiersinga, W. J., Alshamsi, F., Angus, D. C., Arabi, Y., Azevedo, L., Beale, R., Beilman, G., … Levy, M. (2021). Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock 2021. Intensive Care Medicine, 47, 1181–1247. https://doi.org/10.1007/s00134-021-06506-y
• Gordon, A. C., Mason, A. J., Thirunavukkarasu, N., Perkins, G. D., Cecconi, M., Cepkova, M., Pogson, D. G., Aya, H. D., Anjum, A., Frazier, G. J., Santhakumaran, S., Ashby, D., Brett, S. J., & VANISH Investigators. (2016). Effect of early vasopressin vs norepinephrine on kidney failure in patients with septic shock: The VANISH randomized clinical trial. JAMA, 316(5), 509–518. https://doi.org/10.1001/jama.2016.10485
• Gorordo-Delsol, L. A., Merinos-Sánchez, G., Morales-Segura, M. A. M., Villaseñor-Morales, C., & Hernández-López, G. D. (2020). Sepsis and septic shock in emergency departments of Mexico: Multicenter point-prevalence study. Gaceta Médica de México, 156(6), 486–492.
• Jia, L., Li, Z., Wang, Y., Xu, Y., & Wu, H. (2023). Vasoactive agents for septic shock: A systematic review and network meta-analysis. Frontiers in Pharmacology, 14, 1172859. https://doi.org/10.3389/fphar.2023.1172859
• Khanna, A., English, S. W., Wang, X. S., Ham, K., Tumlin, J., Szerlip, H., Busse, L. W., Altaweel, L., Albertson, T. E., Mackey, C., McCurdy, M. T., Boldt, D. W., Chock, S., Young, P. J., Krell, K., Wunderink, R. G., Ostermann, M., Murugan, R., Gong, M. N., … ATHOS-3 Investigators. (2017). Angiotensin II for the treatment of vasodilatory shock. The New England Journal of Medicine, 377(5), 419–430. https://doi.org/10.1056/NEJMoa1704154
• Kotani, Y., Matchett, G., & Landoni, G. (2025). Haemodynamic management of septic shock. Intensive Care Medicine.
• Ortiz, G., Dueñas, C., Rodríguez, F., Barrera, L., de La Rosa, G., Dennis, R., Granados, M., Londoño, D., Molina, F., Jaimes, F., & Sepsis Study Group. (2014). Epidemiology of sepsis in Colombian intensive care units. Biomédica, 34(1), 40–47.
• Ospina-Tascón, G. A., Hernandez, G., Alvarez, I., Calderón-Tapia, L. E., Manzano-Nunez, R., Sánchez-Ortiz, A. I., Quiñones, E., Ruiz-Yucuma, J. E., Aldana, J. L., Teboul, J. L., & Cavalcanti, A. B. (2020). Effects of very early start of norepinephrine in patients with septic shock: A propensity score-based analysis. Critical Care, 24, 52. https://doi.org/10.1186/s13054-020-2756-3
• Permpikul, C., Tongyoo, S., Viarasilpa, T., Trainarongsakul, T., Chakorn, T., & Udompanturak, S. (2019). Early use of norepinephrine in septic shock resuscitation (CENSER): A randomized trial. American Journal of Respiratory and Critical Care Medicine, 199(9), 1097–1105. https://doi.org/10.1164/rccm.201806-1034OC
• Ruiz, G. O., Castell, C. D., & Garay, C. J. (2016). Epidemiology of severe infections in Latin American intensive care units. Revista Brasileira de Terapia Intensiva, 28(3), 261–271. https://doi.org/10.5935/0103-507X.20160044
• Russell, J. A., Walley, K. R., Singer, J., Gordon, A. C., Hébert, P. C., Cooper, D. J., Holmes, C. L., Mehta, S., Granton, J. T., Storms, M. M., Cook, D. J., Presneill, J. J., & Ayers, D. (2008). Vasopressin versus norepinephrine infusion in patients with septic shock. The New England Journal of Medicine, 358(9), 877–887. https://doi.org/10.1056/NEJMoa067373
• Shi, R., Hamzaoui, O., De Vita, N., Monnet, X., & Teboul, J. L. (2020). Vasopressors in septic shock: Which, when, and how much? Annals of Translational Medicine, 8(12), 794. https://doi.org/10.21037/atm.2020.04.24
• Society of Critical Care Medicine. (2026). Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock 2026. SCCM.
• Vélez, J. W., Barros, A. J. D., Calderón, A., & Vera, C. (2022). Risk factors for mortality from sepsis in an intensive care unit in Ecuador: A prospective cohort study. International Journal of Infectious Diseases, 116, 87–94. https://doi.org/10.1016/j.ijid.2022.01.034
• Zhou, F., Mao, Z., Zeng, X., Kang, H., Liu, H., Pan, L., Hou, P., & Wang, L. (2015). Vasopressors in septic shock: A systematic review and network meta-analysis. Therapeutics and Clinical Risk Management, 11, 1047–1059. https://doi.org/10.2147/TCRM.S80060
