92 - Inotropes and vasopressors

Abstract

The pharmacological support of the failing circulation in critically ill patients is directed at restoring and maintaining vital organ perfusion. This is primarily achieved by the administration of intravenous fluids in hypovolaemic patients and augmented by the early and concomitant use of infusions of catecholamines, noradrenaline or adrenaline. These drugs should be used to augment inadequate endogenous responses and are effective at increasing mean arterial pressure, cardiac output and venous return. Current evidence supports the use of these drugs as first-line agents for all forms of shock, although the evidence base is limited. There is little evidence to support the use of synthetic catecholamines or other drugs such as phosphodiesterase inhibitors. Drugs should be titrated to a patient-specific mean arterial pressure and at clinical indices of vital organ function.