Abstract
Vasopressor and inotropic agents have become a therapeutic cornerstone for the management of the critically ill patient. Vasopressors increase blood pressure through arteriolar vasoconstriction, whereas the inotropes increase contractility, improving cardiac output. Most vasopressor and inotropic agents in clinical use exert their cardiovascular effect by interacting with adrenergic receptors in the heart and blood vessels. Although the optimum vasopressor agent for hypotensive patients after fluid resuscitation remains an area of controversy, the most popular is norepinephrine. In heart failure and cardiogenic shock, no data favor the use of one inotropic agent over another, but PDE III inhibitors or levosimendan should be the agent of choice in patients receiving β-blocking agents. In the setting of sepsis and its associated myocardial depression, the Surviving Sepsis Campaign recommends the use of dobutamine. Vasopressors and inotropes can produce serious side effects and should be used for the shortest duration of time and at the lowest dose necessary to establish the therapeutic goal.
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