Vasopressors and Inotropic Therapy

When fluid resuscitation does not provide adequate arterial pressure and organ perfusion, vasopressors and/or inotropic agents should be initiated. Vasopressors are recommended in patients with a systolic blood pressure less than 90 mm Hg or mean arterial pressure (MAP) lower than 60 to 65 mm Hg, after failed treatment with crys-

24 27 28

talloids. ' ' Vasopressors and inotropes are effective in treating life-threatening hypotension and improving cardiac index, but complications such as tachycardia and myocardial ischemia require slow titration of the adrenergic agents to restore MAP without impairing stroke volume. Vasopressor therapy may also be required transiently to sustain life and maintain perfusion in the face of life-threatening hypotension, even when fluid resuscitation is in progress and hypovolemia has not yet been corrected. Agents commonly considered for vasopressor or inotropic support include dopamine, dobutamine, norepinephrine, phenylephrine, and epinephrine. Nore-pinephrine or dopamine are first-line vasopressors to correct hypotension in septic shock.24,27,28

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