Which inotropic agent?

Abstract

In most general paediatric intensive care situations, familiarity with a small number of albeit imperfect drugs is preferable to employing a large array of agents. It is essential to ensure that shock is not due to primary cardiac rhythm disturbance or cardiac tamponade and circulating volume must be adequate. If inappropriate bradycardia is compromising cardiac output isoprenaline can be very effective. If poor myocardial function is present or anticipated dopamine or dobutamine can be used but if there is marked peripheral vaso dilatation dopamine is preferred as it can be used in a dose with alpha as well as beta effects (> 10 μg/kg/min). If peripheral alpha effects are not wanted then dobutamine can be used or the dose of dopamine kept below 10 μg/kg/min. The unusual circumstance of good myocardial function with peripheral dilatation is an indication for an alpha agonist, either noradrenaline or phenylephrine. If pure peripheral dilatation is wanted then phentolamine, prostacyclin or nitroprusside can be used. Digoxin is rarely indicated as an acute inotrope but may be started in a maintenance dose if ongoing cardiac support after intensive care is thought likely to be needed.