[Vasopressors in septic shock: the old and the new].

Authors

Reimer Riessen, David J Heister, Janika Briegel

Published in

Medizinische Klinik, Intensivmedizin und Notfallmedizin. Jul 27, 2026. Epub Jul 27, 2026.

Abstract

Septic shock is characterized by a collapse of physiological circulatory regulation with profound vasoplegia, relative vasopressor insufficiency, and frequently concomitant myocardial dysfunction. In this review, we first outline the physiological roles and interactions of the three key endogenous vasopressor systems-the sympathetic nervous system/noradrenaline, arginine vasopressin, and the renin-angiotensin-aldosterone system-in maintaining blood pressure, organ perfusion, and intravascular volume. We then summarize the main mechanisms of septic vasoplegia. On this basis, we present current recommendations from the 2026 Surviving Sepsis Campaign and the 2025 update of the German S3 guideline on sepsis regarding the use of noradrenaline as a first-line vasopressor and vasopressin as add-on therapy, adrenaline/dobutamine in the setting of cardiac dysfunction, and corticosteroids in refractory shock. Finally, we emphasize the close interdependence of vasopressor therapy and fluid management.

PMID:
42509294
Bibliographic data and abstract were imported from PubMed on 28 Jul 2026.

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