Formulary, restricted to treatment of vasoplegia in the immediate post-operative setting by cardiothoracic surgery. It may only be used after higher doses of norepinephrine and vasopressin have been utilized without a sufficient response, and if other drugs cannot be used or the patient has not responded well to them (i.e. methylene blue, hydroxocobalamin). If no significant benefit is seen within 3-4 hours, angiotensin II should be weaned and discontinued by the provider. Response should be formally reassessed by 48 hours or prior to determine if ongoing therapy is warranted. VTE prophylaxis is required during use.
Criteria for Use (all must be met):
1. Confirmed/suspected vasoplegia:
a. Severe hypotension (MAP <65) refractory to > 2 vasopressors
i. Norepinephrine > 0.15 mcg/kg/min
ii. Vasopressin > 0.04 units/min
b. Low Systemic Vascular Resistance (<800 dynes/sec/cm5)
c. Normal or elevated Cardiac Index (>2.2 L/min/m2)
2. Contraindication to methylene blue and hydroxocobalamin inappropriate (high risk of renal failure)
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Formulary, restricted to treatment of vasoplegia in the immediate post-operative setting by cardiothoracic surgery. It may only be used after higher doses of norepinephrine and vasopressin have been utilized without a sufficient response, and if other drugs cannot be used or the patient has not responded well to them (i.e. methylene blue, hydroxocobalamin). If no significant benefit is seen within 3-4 hours, angiotensin II should be weaned and discontinued by the provider. Response should be formally reassessed by 48 hours or prior to determine if ongoing therapy is warranted. VTE prophylaxis is required during use.
Criteria for Use (all must be met):
1. Confirmed/suspected vasoplegia:
a. Severe hypotension (MAP <65) refractory to > 2 vasopressors
i. Norepinephrine > 0.15 mcg/kg/min
ii. Vasopressin > 0.04 units/min
b. Low Systemic Vascular Resistance (<800 dynes/sec/cm5)
c. Normal or elevated Cardiac Index (>2.2 L/min/m2)
2. Contraindication to methylene blue and hydroxocobalamin inappropriate (high risk of renal failure)
Reviewed: 28 Aug 2018,
Updated: April 2025
Angiotensin II (GIAPREZA) Update_CV Surgery_March 2025 updated.pdf