Role of inotropes and vasopressors therapy in the intensive care unit
Keywords:Inotropes, Vasopressors, Intensive, Care
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.
Motiejunaite J, Deniau B, Blet A, Gayat E, Mebazaa A. Inotropes and vasopressors are associated with increased short-term mortality but not long-term survival in critically ill patients. Anaesthesia Cri Care Pain Med. 2022;41(1):101012.
Kanter J, DeBlieux P. Pressors and inotropes. Emergency Med Clin N Am. 2014;32(4):823-34.
Kulka PJ, Tryba M. Inotropic support of the critically ill patient. A review of the agents. Drugs. 1993;45(5):654-67.
Ferguson-Myrthil N. Vasopressor use in adult patients. Cardiol Rev. 2012;20(3):153-8.
Keller M, Magunia H. Vasopressors: Physiology, Pharmacology and Clinical Applications. Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS. 2021;56(6):400-13.
Carsetti A, Bignami E, Cortegiani A. Good clinical practice for the use of vasopressor and inotropic drugs in critically ill patients: state-of-the-art and expert consensus. Minerva Anestesiologica. 2021;87(6):714-32.
Jentzer JC, Hollenberg SM. Vasopressor and Inotrope Therapy in Cardiac Critical Care. J Intensive Care Med. 2021;36(8):843-56.
Scheeren TWL, Bakker J, Kaufmann T. Current use of inotropes in circulatory shock. Anna Intensive Care. 2021;11(1):21.
Levy B, Buzon J, Kimmoun A. Inotropes and vasopressors use in cardiogenic shock: when, which and how much? Curr Opinion Crit Care. 2019;25(4):384-90.
Shankar A, Gurumurthy G, Sridharan L. A Clinical Update on Vasoactive Medication in the Management of Cardiogenic Shock. Clin Med Insights Cardiol. 2022;16:11795468221075064.
Bangash MN, Kong ML, Pearse RM. Use of inotropes and vasopressor agents in critically ill patients. Bri J Pharmacol. 2012;165(7):2015-33.
Bistola V, Arfaras-Melainis A, Polyzogopoulou E, Ikonomidis I, Parissis J. Inotropes in Acute Heart Failure: From Guidelines to Practical Use: Therapeutic Options and Clinical Practice. Cardiac Failure Rev. 2019;5(3):133-9.
Karami M, Hemradj VV, Ouweneel DM. Vasopressors and Inotropes in Acute Myocardial Infarction Related Cardiogenic Shock: A Systematic Review and Meta-Analysis. J Clin Med. 2020;9(7).
Gao F, Zhang Y. Inotrope Use and Intensive Care Unit Mortality in Patients With Cardiogenic Shock: An Analysis of a Large Electronic Intensive Care Unit Database. Frontiers Cardiovascular Med. 2021;8:696138.
Colling KP, Banton KL, Beilman GJ. Vasopressors in Sepsis. Surgical Infect. 2018;19(2):202-7.
Lodha R, Oleti TP, Kabra SK. Management of septic shock. Indian J Pediatr. 2011;78(6):726-33.
Avni T, Lador A, Lev S, Leibovici L, Paul M, Grossman A. Vasopressors for the Treatment of Septic Shock: Systematic Review and Meta-Analysis. PloS one. 2015;10(8):e0129305.
Stratton L, Berlin DA, Arbo JE. Vasopressors and Inotropes in Sepsis. Emerg Med Clin N Am. 2017;35(1):75-91.
Sato R, Ariyoshi N, Hasegawa D. Effects of Inotropes on the Mortality in Patients With Septic Shock. J Intensive Care Med. 2021;36(2):211-9.