Effect of Vasopressors and Vasodilators on Kidney Medulla Oxygenation

ABSTRACT This narrative review provides a comprehensive summary of research findings up to 2023 regarding the impact of vasopressors and vasodilators on medullary oxygenation during cardiopulmonary bypass and septic shock. It encompasses a thorough evaluation of all current vasopressors and vasodilators. Among vasodilators, levosimendan demonstrates superior efficacy, particularly in cases of heart failure following cardiac surgery. In the context of hypotension during such procedures, vasopressin emerges as the most effective vasopressor. In cases of hypotensive septic shock, both vasopressin and angiotensin II appear to be superior in preserving medullary oxygenation. However, it is imperative to emphasize the need for more robust data and randomized controlled human trials to validate these initial findings. Currently, it would be premature to offer definitive clinical recommendations on this matter.