A global perspective on vasoactive agents in shock

• Published in: Intensive care medicine Vol. 44; no. 6; pp. 833 - 846
• Main Authors: Annane, Djillali, Ouanes-Besbes, Lamia, de Backer, Daniel, DU, Bin, Gordon, Anthony C., Hernández, Glenn, Olsen, Keith M., Osborn, Tiffany M., Peake, Sandra, Russell, James A., Cavazzoni, Sergio Zanotti
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-06-2018; Springer; Springer Nature B.V; Springer Verlag
• Subjects: Anesthesiology; Angiotensin; Angiotensin II; Cardiotonic Agents; Catecholamines; Chemical compounds; Clinical practice guidelines; Complications; Critical care; Critical Care Medicine; Dobutamine - therapeutic use; Drug development; Drugs; Ecology, environment; Emergency Medicine; Esmolol; Health; Health aspects; Humans; Intensive; Intensive Care Units; Life Sciences; Medical colleges; Medicine; Medicine & Public Health; Methylene blue; Norepinephrine; Norepinephrine - therapeutic use; Pain Medicine; Pediatrics; Pharmacists; Pharmacology; Physicians; Pneumology/Respiratory System; Review; Shock; Shock - drug therapy; Shock, Septic; Therapeutic applications; Therapy; Titration; Vasoactive agents; Vasoconstrictor Agents - therapeutic use; Vasopressin; Veins & arteries; Weaning; Shock; Cardiovascular system; Adrenergic agonists; Clinical trials; Practice guidelines
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-018-5242-5

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.