We propose the notion of "broad spectrum vasopressors" wherein patients with septic shock are started on multiple vasopressors with a different mechanism of action simultaneously while the vasopressor sensitivity is assessed. Vasopressor sensitivity could be assessed by sequential removal of vasopressors or developing a vasopressor sensitivity panel. Once the vasopressor sensitivities are assessed, then the vasopressors are de-escalated accordingly. However, this concept is hampered by several issues. Firstly, there is currently no bedside test that predicts the blood pressure response to catecholamines, vasopressin, or angiotensin II. Secondly, not all of these vasopressors are currently available worldwide due to either a lack of regulatory approval or cost considerations. Thirdly, there are no prospective data supporting this approach. Despite these hurdles, we feel that this is a testable hypothesis: Does time to sensitive vasopressor response improve outcomes in septic shock? We suggest this is a question worth answering and may prove an essential approach in managing these critically ill individuals.
FBT: Fluid bolus therapy; MAP: Mean arterial pressure
Availability of data and materials
The datasets analysed for development of this commentary are available from the corresponding author on reasonable request.
Additional data summarized in this commentary are included in the following published articles [and its supplementary information files]:
Sacha GL, Lam SW, Duggal A, Torbic H, Bass SN, Welch SC et al. Predictors of response to fixed-dose vasopressin in adult patients with septic shock. Ann Intensive Care 2018;8 (1):35.
Khanna A, English SW, Wang XS, Ham K, Tumlin J, Szerlip H et al. Angiotensin II for the Treatment of Vasodilatory Shock. N Engl J Med 2017;377 (5):419–30
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Crit Care. 2019;23(124) © 2019 BioMed Central, Ltd.
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