Inotropes, Vasopressors and Vasodilators
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Indications, selection and duration of inotropic support during and following cardiac surgery remain variable and controversial. Nevertheless, it is employed frequently for anticipated or manifest hemodynamic instability ranging from low cardiac output to established shock stages. This chapter provides a background, justification and overview of inotropic and vasopressor therapy with a strong clinical rather than molecular and pharmacological focus. Current treatment strategies and principles of crucial aspects of medical management are discussed. The main clinical classification of inotropes and to a lesser degree vasoactive agents is included as well as clinical utilities of the most frequently used agents are described. Due to the significance of right ventricular dysfunction a section is dedicated to the right ventricle and pulmonary circulation. Finally, a summary of treatment strategies for the most common clinical scenarios is provided.
KeywordsHypotension Low cardiac output Inotropes Inopressors Inodilators Inhaled nitric oxide
- 12.McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, et al. ESC committee for practice guidelines. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European society of cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33:1787–847.CrossRefGoogle Scholar
- 21.Cholley B, Caruba T, Grosjean S, Amour J, Ouattara A, Villacorta J, et al. Effect of Levosimendan on low cardiac output syndrome in patients with low ejection fraction undergoing coronary artery bypass grafting with cardiopulmonary bypass: The LICORN randomized clinical trial. JAMA. 2017;318:548–56.CrossRefGoogle Scholar
- 25.Harjola VP, Mebazaa A, Celutkiene J, Bettex D, Bueno H, Chioncel O, et al. Contemporary management of acute right ventricular failure: a statement from the heart failure association and the working group on pulmonary circulation and right ventricular function of the European society of cardiology. Eur J Heart Fail. 2016;18:226–41.CrossRefGoogle Scholar