Inappropriateness of “Inotropic” Support with Epinephrine
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.
KeywordsStroke Volume Ventricular Pressure Stroke Work Intermittent Positive Pressure Ventilation Inotropic State
Unable to display preview. Download preview PDF.
- 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.Noble MIM (1978) The Frank-Starling curve. Clinical Science 54:1–7Google Scholar
- 5.Noble MIM (1979) The cardiac cycle. Blackwell, OxfordGoogle Scholar
- 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.Jacob R, Seipel L, Zucker GH (eds) (1990) Cardiac dilatation. Gustav Fischer, StuttgartGoogle Scholar
- 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.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
- 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