A global perspective on vasoactive agents in shock

A global perspective on vasoactive agents in shock Purpose: We set out to summarize the current knowledge on vasoactive drugs and their use in the management of shock to inform physicians’ practices. Methods: This is a narrative review by a multidisciplinary, multinational—from six continents—panel of experts including physicians, a pharmacist, trialists, and scientists. Results and conclusions: Vasoactive drugs are an essential part of shock management. Catecholamines are the most commonly used vasoactive agents in the intensive care unit, and among them norepinephrine is the first ‑ line therapy in most clinical conditions. Inotropes are indicated when myocardial function is depressed and dobutamine remains the first ‑ line therapy. Vasoactive drugs have a narrow therapeutic spectrum and expose the patients to potentially lethal complications. Thus, these agents require precise therapeutic targets, close monitoring with titration to the minimal efficacious dose and should be weaned as promptly as possible. Moreover, the use of vasoactive drugs in shock requires an individualized approach. Vasopressin and possibly angiotensin II may be useful owing to their norepinephrine‑ sparing effects. Keywords: Shock, Cardiovascular system, Adrenergic agonists, Clinical trials, Practice guidelines review provides a summary of current knowledge about Introduction vasopressors and inotropes to guide intensive care physi- Acute illnesses are often characterized by a http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Intensive Care Medicine Springer Journals

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Publisher
Springer Berlin Heidelberg
Copyright
Copyright © 2018 by Springer-Verlag GmbH Germany, part of Springer Nature and ESICM
Subject
Medicine & Public Health; Intensive / Critical Care Medicine; Anesthesiology; Emergency Medicine; Pneumology/Respiratory System; Pain Medicine; Pediatrics
ISSN
0342-4642
eISSN
1432-1238
D.O.I.
10.1007/s00134-018-5242-5
Publisher site
See Article on Publisher Site

Abstract

Purpose: We set out to summarize the current knowledge on vasoactive drugs and their use in the management of shock to inform physicians’ practices. Methods: This is a narrative review by a multidisciplinary, multinational—from six continents—panel of experts including physicians, a pharmacist, trialists, and scientists. Results and conclusions: Vasoactive drugs are an essential part of shock management. Catecholamines are the most commonly used vasoactive agents in the intensive care unit, and among them norepinephrine is the first ‑ line therapy in most clinical conditions. Inotropes are indicated when myocardial function is depressed and dobutamine remains the first ‑ line therapy. Vasoactive drugs have a narrow therapeutic spectrum and expose the patients to potentially lethal complications. Thus, these agents require precise therapeutic targets, close monitoring with titration to the minimal efficacious dose and should be weaned as promptly as possible. Moreover, the use of vasoactive drugs in shock requires an individualized approach. Vasopressin and possibly angiotensin II may be useful owing to their norepinephrine‑ sparing effects. Keywords: Shock, Cardiovascular system, Adrenergic agonists, Clinical trials, Practice guidelines review provides a summary of current knowledge about Introduction vasopressors and inotropes to guide intensive care physi- Acute illnesses are often characterized by a

Journal

Intensive Care MedicineSpringer Journals

Published: Jun 4, 2018

References

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