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Catecholamines for inflammatory shock: a Jekyll-and-Hyde conundrum

Andreis, DT; Singer, M; (2016) Catecholamines for inflammatory shock: a Jekyll-and-Hyde conundrum. Intensive Care Medicine , 42 (9) pp. 1387-1397. 10.1007/s00134-016-4249-z. Green open access

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Abstract

Catecholamines are endogenous neurosignalling mediators and hormones. They are integral in maintaining homeostasis by promptly responding to any stressor. Their synthetic equivalents are the current mainstay of treatment in shock states to counteract myocardial depression and/or vasoplegia. These phenomena are related in large part to decreased adrenoreceptor sensitivity and altered adrenergic signalling, with resultant vascular and cardiomyocyte hyporeactivity. Catecholamines are predominantly used in supraphysiological doses to overcome these pathological consequences. However, these adrenergic agents cause direct organ damage and have multiple ‘off-target’ biological effects on immune, metabolic and coagulation pathways, most of which are not monitored or recognised at the bedside. Such detrimental consequences may contribute negatively to patient outcomes. This review explores the schizophrenic ‘Jekyll-and-Hyde’ characteristics of catecholamines in critical illness, as they are both necessary for survival yet detrimental in excess. This article covers catecholamine physiology, the pleiotropic effects of catecholamines on various body systems and pathways, and potential alternatives for haemodynamic support and adrenergic modulation in the critically ill.

Type: Article
Title: Catecholamines for inflammatory shock: a Jekyll-and-Hyde conundrum
Open access status: An open access version is available from UCL Discovery
DOI: 10.1007/s00134-016-4249-z
Publisher version: http://dx.doi.org/10.1007/s00134-016-4249-z
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Science & Technology, Life Sciences & Biomedicine, Critical Care Medicine, General & Internal Medicine, Catecholamines, Epinephrine, Norepinephrine, Physiology, Pathophysiology, Critical illness, Sepsis, Escherichia-Coli O157-H7, Beta-Adrenergic-Blockade, Critically-Ill Patients, Acute Ischemic-Stroke, Heart-Rate Control, Septic Shock, Severe Sepsis, Systemic Inflammation, Hepatocellular Dysfunction, Myocardial Dysfunction
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Experimental and Translational Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/10043229
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