Vasoactive drugs in the intensive care unit
- PMID: 16175026
- DOI: 10.1097/01.ccx.0000176696.70013.da
Vasoactive drugs in the intensive care unit
Abstract
Purpose of the review: Vasoactive drugs are the mainstay of hemodynamic management of vasodilatory shock when fluids fail to restore tissue perfusion. In this review, studies published during the past year that increase our understanding of the use of vasoactive drugs in the intensive care unit are discussed.
Recent findings: In septic shock, there is no benefit in increasing mean arterial pressure from 65 to 85 mmHg. Norepinephrine did not worsen renal function. Epinephrine induced visceral hypoperfusion and hyperlactatemia, and worsened organ function and survival compared with norepinephrine and vasopressin. There are a number of reports of the safety and efficacy of vasopressin but it is not currently recommended as first line therapy, and if used, should be given as a continuous low dose infusion. Terlipressin is showing promise but decreases cardiac output. Metaraminol is being investigated as an alternative to norepinephrine. Dopamine may improve splanchnic flow mainly by increasing cardiac output. Dobutamine improves oxygen delivery and may improve mesenteric blood flow.
Summary: Over the last 40 years, there have been few controlled clinical trials to guide clinicians on the use of vasoactive drugs of treating shock states. It is not known whether the currently favored combination of norepinephrine and dobutamine is superior to traditional therapy with dopamine. Epinephrine is not recommended as the first-line therapy. The role of vasopressin and terlipressin remains unknown. Three large ongoing clinical trials will be completed soon and the results should clarify the role of these various agents.
Similar articles
-
Continuous terlipressin versus vasopressin infusion in septic shock (TERLIVAP): a randomized, controlled pilot study.Crit Care. 2009;13(4):R130. doi: 10.1186/cc7990. Epub 2009 Aug 10. Crit Care. 2009. PMID: 19664253 Free PMC article. Clinical Trial.
-
THE EFFICACY AND SAFETY OF VASOPRESSORS FOR SEPTIC SHOCK PATIENTS: A SYSTEMIC REVIEW AND NETWORK META-ANALYSIS.Shock. 2023 Dec 1;60(6):746-752. doi: 10.1097/SHK.0000000000002193. Epub 2023 Aug 4. Shock. 2023. PMID: 37548686
-
Vasopressin and terlipressin in adult vasodilatory shock: a systematic review and meta-analysis of nine randomized controlled trials.Crit Care. 2012 Aug 14;16(4):R154. doi: 10.1186/cc11469. Crit Care. 2012. PMID: 22889256 Free PMC article. Review.
-
Vasoactive drugs for vasodilatory shock in ICU.Curr Opin Crit Care. 2009 Oct;15(5):398-402. doi: 10.1097/MCC.0b013e32832e96ef. Curr Opin Crit Care. 2009. PMID: 19542884 Review.
-
Effects of short-term simultaneous infusion of dobutamine and terlipressin in patients with septic shock: the DOBUPRESS study.Br J Anaesth. 2008 Apr;100(4):494-503. doi: 10.1093/bja/aen017. Epub 2008 Feb 27. Br J Anaesth. 2008. PMID: 18308741 Clinical Trial.
Cited by
-
Acute liver failure in adults: an evidence-based management protocol for clinicians.Gastroenterol Hepatol (N Y). 2012 Mar;8(3):161-212. Gastroenterol Hepatol (N Y). 2012. PMID: 22675278 Free PMC article.
-
Predictors of hospital-acquired pressure injuries in patients with complete spinal cord injury: a retrospective case-control study.BMC Musculoskelet Disord. 2023 Apr 26;24(1):329. doi: 10.1186/s12891-023-06369-y. BMC Musculoskelet Disord. 2023. PMID: 37101130 Free PMC article.
-
Evaluation of liver function tests after coronary artery bypass surgery (CABG).Caspian J Intern Med. 2021 Winter;12(1):45-52. doi: 10.22088/cjim.12.1.45. Caspian J Intern Med. 2021. PMID: 33680397 Free PMC article.
-
Rescue treatment with terlipressin in children with refractory septic shock: a clinical study.Crit Care. 2006 Feb;10(1):R20. doi: 10.1186/cc3984. Crit Care. 2006. PMID: 16469127 Free PMC article.
-
An unusual case of nonocclusive mesenteric ischemia in a young girl.Indian J Crit Care Med. 2012 Jan;16(1):28-30. doi: 10.4103/0972-5229.94423. Indian J Crit Care Med. 2012. PMID: 22557829 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical
Research Materials
Miscellaneous