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Intensive Care Medicine
Published in: Intensive Care Medicine 6/2018

01-06-2018 | Review

A global perspective on vasoactive agents in shock

Authors: 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

Published in: Intensive Care Medicine | Issue 6/2018

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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.
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Metadata
Title
A global perspective on vasoactive agents in shock
Authors
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
Publication date
01-06-2018
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 6/2018
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-018-5242-5

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