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dc.contributor.authorBellomo, Rinaldoen
dc.contributor.authorWan, Lien
dc.contributor.authorMay, Clive Nen
dc.identifier.citationCritical Care Medicine; 36(4 Suppl): S179-86en
dc.description.abstractThe use of norepinephrine, and probably vasopressor therapy in general, in intensive care patients with hypotensive vasodilatation despite fluid resuscitation and evidence of acute kidney injury remains the subject of much debate and controversy. Although there is concern about the use of these drugs, these concerns are unfounded. At this time, the experimental and human data strongly suggest that, in these patients, vasopressor therapy is safe and probably beneficial from a renal, and probably general, point of view. On the basis of currently available evidence, in hypotensive vasodilated patients with acute kidney injury, restoration of blood pressure within autoregulatory values should occur promptly with noradrenaline and be sustained until such vasodilatation dissipates. The additional role of other vasopressors in these situations remains unclear. The addition of vasopressin may be helpful in individual patients, but widespread use is not supported by evidence. Alpha-dose dopamine has no advantages over noradrenaline and is not as reliably effective in restoring blood pressure and urine output. Its widespread use cannot be supported in patients with vasodilatation and acute kidney injury. Other vasopressor drugs such as epinephrine and phenylephrine may be similar in efficacy to noradrenaline. However, experience and available data with their use is vastly less than with noradrenaline. Adrenaline, in addition, is associated with hyperglycemia, hyperlactatemia, acidosis, and hypokalemia. Terlipressin appears useful in patients with acute kidney injury secondary to hepatorenal syndrome. Whether it is superior to noradrenaline in this setting remains uncertain, and more studies are needed before recommendations can be made.en
dc.subject.otherAcute Kidney Injury.complications.drug therapyen
dc.subject.otherBlood Pressure.drug effectsen
dc.subject.otherCritical Careen
dc.subject.otherGlomerular Filtration Rate.drug effectsen
dc.subject.otherHypotension.drug therapy.etiologyen
dc.subject.otherNorepinephrine.administration & dosage.therapeutic useen
dc.subject.otherRenal Circulation.drug effectsen
dc.subject.otherVasoconstrictor Agents.therapeutic useen
dc.subject.otherVasopressins.administration & dosage.therapeutic useen
dc.titleVasoactive drugs and acute kidney injury.en
dc.typeJournal Articleen
dc.identifier.journaltitleCritical Care Medicineen
dc.identifier.affiliationDepartment of Intensive Care and Medicine, Austin Hospital, Melbourne, Australiaen
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