LAUSR

Unacceptably high rates of mortality in critically ill patients, including those under cardiopulmonary bypass (CPB), are a reality that keeps itself through time, despite advances in pharmacology and technology. Shock treatment initiated with fluid resuscitation strategies and administration of adrenergic vasopressor agents in nonresponsive patients to restore arterial pressure and protect the microcirculation. High catecholamine (norepinephrine) dosing requirements are necessary to achieve targeted hemodynamic goals, increasing the risk of vasopressor-induced adverse events. In addition, catecholamines are associated with well-known side effects, including increased myocardial oxygen consumption and development of arrhythmias, which are two compromising conditions of good evolution even of elective cardiac surgeries[1]. Catecholamines are predominantly used in supraphysiological doses to overcome the consequences of pathological inflammatory shock. However, these adrenergic agents cause direct organ damage and have multiple harmful biological effects on immune, metabolic and coagulation pathways, with negatively patient outcomes. Andreis & Singer[2] appropriately called this situation “the schizophrenic ‘Jekyll-and-Hyde’ catecholamines characteristics in critical illness”, as they are both necessary for survival although detrimental in excess. It is clear that this Jekyll-and-Hyde drama was based on the microcirculatory detrimental of high and prolonged use of catecholamines. Therefore, it is imperative to find ways of protecting microcirculation against the deleterious effects of catecholamines, justifying the motivation of this Editorial about “Vasopressor Support Sparing Strategies” as a concept to be incorporated as a paradigm in the treatment of vasodilatory shock[2]. Few randomized studies exist to guide clinical management and hemodynamic stabilization in patients who do not respond to the standard approach (fluid resuscitation and norepinephrine). EDITORIAL