The medical treatment of cardiogenic shock: cardiovascular drugs.
Curr Opin Crit Care
; 27(4): 426-432, 2021 08 01.
Article
en En
| MEDLINE
| ID: mdl-33797431
ABSTRACT
PURPOSE OF REVIEW To discuss the use of vasopressors and inotropes in cardiogenic shock. RECENT FINDINGS:
The classic form or cardiogenic shock requires administration of inotropic and/or vasopressor agents to try to improve the impaired tissue perfusion. Among vasopressors various alpha-adrenergic agents, vasopressin derivatives and angiotensin can be used. The first-line therapy remains norepinephrine as it is associated with minimal adverse effects and appears to be associated by the best outcome in network meta-analyses. On the contrary, epinephrine is associated with an increased incidence of refractory shock and observational studies suggest an increased risk of death. Vasopressin may be an excellent alternative in tachycardiac patients or in the presence of pulmonary hypertension. Concerning inotropic agents, dobutamine is the first-line agent but levosimendan is an excellent alternative or additional agent in cases not responding to dobutamine. The impact on outcome of inotropic agents remains controversial.SUMMARY:
Recent studies have refined the position of the various vasopressor and inotropic agents. Norepinephrine is recommended as first-line vasopressor agent by various guidelines. Among inotropic agents, selection between the agents should be individualized and based on the hemodynamic response.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Choque
/
Fármacos Cardiovasculares
Tipo de estudio:
Guideline
/
Observational_studies
Límite:
Humans
Idioma:
En
Revista:
Curr Opin Crit Care
Asunto de la revista:
TERAPIA INTENSIVA
Año:
2021
Tipo del documento:
Article
País de afiliación:
Bélgica