Faculty Bibliography

OBJECTIVES/OBJECTIVE:To assess the early physiologic response to angiotensin-II treatment in patients with coronavirus disease 2019-induced respiratory failure and distributive shock. DESIGN/METHODS:Retrospective consecutive-sample cohort study. SETTING/METHODS:Three medical ICUs in New York during the coronavirus disease 2019 outbreak. PATIENTS/METHODS:All patients were admitted to the ICU with respiratory failure and were receiving norepinephrine for distributive shock. INTERVENTIONS/METHODS:The treatment groups were patients who received greater than or equal to 1 hour of angiotensin-II treatment. Time-zero was the time of angiotensin-II initiation. Controls were identified using a 2:1 hierarchical process that matched for 1) date and unit of admission; 2) specific organ support modalities; 3) age; 4) chronic lung, cardiovascular, and kidney disease; and 5) sex. Time-zero in the control group was 21 hours post vasopressor initiation, the mean duration of vasopressor therapy prior to angiotensin-II initiation in the treated group. MEASUREMENTS AND MAIN RESULTS/RESULTS:= 0.0002). Compared with controls, angiotensin-II-treated patients had significantly faster improvement in mean arterial pressure, hypercapnia, acidosis, baseline-corrected creatinine, and d-dimer. Three thrombotic events occurred, all in control patients. CONCLUSIONS:Angiotensin-II treatment for coronavirus disease 2019-induced distributive shock was associated with rapid improvement in multiple physiologic indices. Angiotensin-II in coronavirus disease 2019-induced shock warrants further study.