Role of inotropes and vasopressors therapy in the intensive care unit

Abstract

Vasopressors and inotropes are often administered to critically ill patients in intensive care unit for the management and treatment of haemodynamic impairment, heart failure, septic and cardiogenic shock, trauma among certain other diseases. In patients with shock, vasopressors and inotropes are used to induce vasoconstriction or enhance cardiac contractility. Vasopressors induces vasoconstriction, which causes systemic vascular resistance, leading to increase in mean arterial pressure and elevates organ perfusion. While inotropes raise cardiac output, which helps maintain mean arterial pressure and body perfusion. Due to a decreased risk of side effects compared to other catecholamine vasopressors, norepinephrine is considered a first-line vasopressor titrated to attain an optimal arterial pressure. An inotrope such as dobutamine may be given to raise cardiac output to a sufficient level to fulfil tissue demand if tissue and organ perfusion still is not enough. Due to their strengthening effect on cardiac contractility, inotropes have been utilized in the care of patients with heart failure for decades, particularly for patients with systolic dysfunction, or heart failure with reduced ejection fraction. Along with their beneficial inotropic impact, they also have chronotropic and peripheral vascular effects. For patients with severely reduced cardiac output and peripheral organ hypoperfusion, they are most frequently employed in intensive care unit. Along with their benefits they are also associated with certain considerate side-effects. The purpose of this research is to review the available information about role of inotropes and vasopressors therapy in the intensive care unit.