A global perspective on vasoactive agents in shock

Djillali Annane, Lamia Ouanes-Besbes, Daniel de Backer, Bin Du, Anthony C. Gordon, Glenn Hernández, Keith M. Olsen, Tiffany M. Osborn, Sandra Peake, James A. Russell, Sergio Zanotti Cavazzoni

Research output: Contribution to journalReview articlepeer-review

23 Scopus citations

Abstract

Purpose: We set out to summarize the current knowledge on vasoactive drugs and their use in the management of shock to inform physicians’ practices. Methods: This is a narrative review by a multidisciplinary, multinational—from six continents—panel of experts including physicians, a pharmacist, trialists, and scientists. Results and conclusions: Vasoactive drugs are an essential part of shock management. Catecholamines are the most commonly used vasoactive agents in the intensive care unit, and among them norepinephrine is the first-line therapy in most clinical conditions. Inotropes are indicated when myocardial function is depressed and dobutamine remains the first-line therapy. Vasoactive drugs have a narrow therapeutic spectrum and expose the patients to potentially lethal complications. Thus, these agents require precise therapeutic targets, close monitoring with titration to the minimal efficacious dose and should be weaned as promptly as possible. Moreover, the use of vasoactive drugs in shock requires an individualized approach. Vasopressin and possibly angiotensin II may be useful owing to their norepinephrine-sparing effects.

Original languageEnglish (US)
Pages (from-to)833-846
Number of pages14
JournalIntensive Care Medicine
Volume44
Issue number6
DOIs
StatePublished - Jun 1 2018

Keywords

  • Adrenergic agonists
  • Cardiovascular system
  • Clinical trials
  • Practice guidelines
  • Shock

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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