Vasodilatory shock is a life-threatening syndrome in critically ill patients and is characterized by severe
hypotension and resultant tissue hypoperfusion. This shock state requires the use of vasopressor agents to
restore adequate vascular tone.
Norepinephrine is still recommended as first-line vasopressor in the management of critically ill patients suffering
from severe vasodilation. In the recent time, catecholaminergic vasopressor drugs have been associated with
possible side effects at higher dosages. This so-called catecholamine toxicity has focused on alternative noncatecholaminergic
vasopressors or the use of moderate doses of multiple vasopressors with complementary
mechanisms of action. Besides vasopressin and terlipressin, angiotensin II may be a promising drug for the management
of vasodilatory shock. In addition, adjunctive drugs, such as hydrocortisone, methylene blue or ascorbic
acid can be added to conventional vasopressor therapy.
The objective of this review is to give an overview of the current available vasopressor agents used in vasodilatory
shock. A thorough search of PubMed was conducted in order to identify the majority of studies related to the
subject. Data on the outcome of several drugs and future perspective of possible management strategies for the
therapy of vasodilatory shock are discussed.