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Intensive Care Medicine
Published in: Intensive Care Medicine 9/2016

01-09-2016 | Review

Catecholamines for inflammatory shock: a Jekyll-and-Hyde conundrum

Authors: Davide Tommaso Andreis, Mervyn Singer

Published in: Intensive Care Medicine | Issue 9/2016

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Abstract

Catecholamines are endogenous neurosignalling mediators and hormones. They are integral in maintaining homeostasis by promptly responding to any stressor. Their synthetic equivalents are the current mainstay of treatment in shock states to counteract myocardial depression and/or vasoplegia. These phenomena are related in large part to decreased adrenoreceptor sensitivity and altered adrenergic signalling, with resultant vascular and cardiomyocyte hyporeactivity. Catecholamines are predominantly used in supraphysiological doses to overcome these pathological consequences. However, these adrenergic agents cause direct organ damage and have multiple ‘off-target’ biological effects on immune, metabolic and coagulation pathways, most of which are not monitored or recognised at the bedside. Such detrimental consequences may contribute negatively to patient outcomes. This review explores the schizophrenic ‘Jekyll-and-Hyde’ characteristics of catecholamines in critical illness, as they are both necessary for survival yet detrimental in excess. This article covers catecholamine physiology, the pleiotropic effects of catecholamines on various body systems and pathways, and potential alternatives for haemodynamic support and adrenergic modulation in the critically ill.
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Metadata
Title
Catecholamines for inflammatory shock: a Jekyll-and-Hyde conundrum
Authors
Davide Tommaso Andreis
Mervyn Singer
Publication date
01-09-2016
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 9/2016
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-016-4249-z

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