Update 1991 pp 81-89 | Cite as

Inappropriateness of “Inotropic” Support with Epinephrine

  • M. I. M. Noble
Conference paper
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 14)


As director of the Coronary Care Units in our Hospitals, it is my wont to attend patients with cardiac problems in the Intensive Care Units (ICU). It is with some sadness that I still find epinephrine commonly infused into patients requiring so called “inotropic support”. Upon enquiry into the true reason for giving this therapy, I often find that the answer boils down to treatment of low blood pressure. There is often no evidence presented that the inotropic state of the heart is compromised; indeed these patients may sometimes have no cardiac disease, or no evidence for an acute cardiac depression. It is also depressing to find that such patients frequently have central venous lines or even pulmonary artery (Swan-Ganz) catheters in place, but no attempt is made to measure cardiac output.


Stroke Volume Ventricular Pressure Stroke Work Intermittent Positive Pressure Ventilation Inotropic State 
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  1. 1.
    Frank O (1895) Zur Dynamik des Herzmuskels. Zeitschrift für Biologie 32:370–477 (translated by Chapman CB, Wasserman E (1959) Am Heart J 58:282–317, 467–478)Google Scholar
  2. 2.
    Noble MIM (1978) The Frank-Starling curve. Clinical Science 54:1–7Google Scholar
  3. 3.
    Sagawa K (1978) The ventricular pressure-volume diagram revisited. Circ Res 43:677–687PubMedGoogle Scholar
  4. 4.
    Weber KT, Janicki JS, Hefner LL (1976) Left ventricular force-length relations of iso-volumic and ejecting contractions. Am J Physiol 231:337–343PubMedGoogle Scholar
  5. 5.
    Noble MIM (1979) The cardiac cycle. Blackwell, OxfordGoogle Scholar
  6. 6.
    ter Keurs HEDJ, Noble MIM (1988) Starling’s law of the heart revisited. Kluwer Academic Publishers, DordrechtCrossRefGoogle Scholar
  7. 7.
    Noble MIM (1988) Cardiovascular response to fluid loading. Bailliere’s Clinical Anaesthe-siology 2:483–487CrossRefGoogle Scholar
  8. 8.
    Sarnoff SJ, Mitchell JH (1962) The control of the function of the heart. In: American Physiological Society (ed) Handbook of physiology, Sec 2. Circulation I:489Google Scholar
  9. 9.
    Jacob R, Seipel L, Zucker GH (eds) (1990) Cardiac dilatation. Gustav Fischer, StuttgartGoogle Scholar
  10. 10.
    Shoemaker WC, Appel PL, Kram HB (1988) Intraoperative oxygen debt: a determinant of multi-organ failure and other complications. Crit Care Med 16:413–421Google Scholar
  11. 11.
    Rooke GA, Feigl (1983) Work as a correlate of canine left ventricular oxygen consumption, and the problem of catecholamine oxygen wasting. Circ Res 50:273–286Google Scholar
  12. 12.
    Unverferth DV, Blanforth M, Kates E, et al. (1980) Tolerance to dobutamine after a 72 hour continuous infusion. Am J Med 69:262–266PubMedCrossRefGoogle Scholar
  13. 13.
    Treese N, Erbel R, Rhein S, Heinrichs KJ, Meyer J (1989) Additive effects of enoximone and nitroprusside in unstable chronic heart failure. Europ Heart J 10:484–492Google Scholar
  14. 104.
    Crawford MH, Richards KL, Sodums MT, Kennedy (1984) Positive inotropic and vasodilator effects of MDL 17043 in patients with reduced left ventricular performance. Am J Cardiol 53:1051–1053PubMedCrossRefGoogle Scholar
  15. 15.
    Bihari D, Smithers M, Gimson A, Tinker J (1987) The effects of vasodilation with prostacyclin on oxygen delivery and uptake in critically ill patients. N Engl J Med 117:397–403CrossRefGoogle Scholar
  16. 16.
    Preiser JC, Armistead C, Le Minh T, Vincent JL (1989) Increase in oxygen supply during experimental septic shock: the effect of dobutamine versus dopexamine. J Crit Care 4:40–44CrossRefGoogle Scholar
  17. 17.
    Vincent JL, Madhoun P, Primo G, Kahn RJ (1989) Potentiation of the effects of enoximone by dobutamine infusion. Intensive Care Med 15:530–531PubMedCrossRefGoogle Scholar
  18. 18.
    Uretsky BF, Lawless CE, Verbaiis JG, Valdes AM, Kolesar JA, Reddy PS (1987) Combined therapy with dobutamine and amrinone in severe heart failure. Chest 92:657–662PubMedCrossRefGoogle Scholar
  19. 19.
    Gage J, Rutman H, Lucido D, LeJemtel TH (1986) Additive effects of dobutamine and amrinone on myocardial contractility and ventricular performance in patients with severe heart failure. Circulation 74:362–373CrossRefGoogle Scholar
  20. 20.
    Weber KT, Janicki JS, Reeves RC, Hefner LL, Reeves TJ (1974) Determinants of stroke volume in the isolated canine heart. J Appl Physiol 37:742–747PubMedGoogle Scholar

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© Springer-Verlag Berlin, Heidelberg 1991

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  • M. I. M. Noble

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