Fig. 2
From: The apelinergic system as an alternative to catecholamines in low-output septic shock
Hemodynamic drug support in septic shock-related myocardial dysfunction: pharmacological state-of-the-art evidence and new approach concepts. Current recommendations after optimal fluid resuscitation are the introduction of adrenergic agonists with emphasis on the β1AR agonist dobutamine when cardiac index remains low, and somewhat often a hyporesponsiveness/increased dosage profile along with β1AR myocardial down-regulation. In spite of this decreased AR availability, cardioprotection and improved survival have been obtained with β1AR blockade. Apelinergic agonists offer cardio-protection and improved outcomes with a high responsiveness/dosage profile at the pre-clinical side. References supporting assumptions are cited in the text. ELA Eleabela