Journal Club Summary
Khanna A, et al.
N Engl J Med. 2017 Aug 3;377(5):419-430.
Angiotensin II for the Treatment of Vasodilatory Shock – Promise and Caution.
Dellinger RP, et al.
N Engl J Med. 2017 Aug 3;377(5):486-487.
Methodology Score: 4/5
Usefulness Score: 3.5/5
Question and Methods: International multicenter placebo-controlled RCT evaluating the effectiveness of angiotensin II for the treatment of patients with vasodilatory shock refractory to IV fluids and high-dose norepinephrine
Findings: Improvement in MAP seen in 69.9% of patients in angiotensin II group vs 23.4% placebo (OR 7.95)
Limitations: Mortality benefit is unknown, pharmacy-funded study, ICU population
Interpretation: Further studies are needed to establish indications for use (monotherapy vs synergy with other vasopressors), potential side effects to therapy and whether there is a mortality benefit.
By: Dr. Lauren Lacroix
A surrogate outcome is often used in place of a truly clinically important outcome. This outcome is chosen usually due to feasibility and cost factors. To obtain a truly clinically important outcome (e.g. survival), it may take a lot longer to obtain an adequate sample size and this often is associated with a much higher costs. It may be appropriate to use the surrogate if it is truly directly related to the outcome; if not, than it usually is not a suitable outcome and further study is needed.
By: Dr. Jeff Perry