Inotropes and vasopressores - Cardiff PICU

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Available inotropes and pressors◦ Natural catecholamines• Adrenaline• Noradrenaline• Dopamine◦ Synthetic catecholamines• Dobutamine◦ Phosphodiesterase inhibitors• Milrinone, enoximone◦ Pure pressors• Vasopressin, Terlipressin
Choice of inotrope◦ Personal preference◦ No RCT to rely on◦ Prejudices common – rememberthese are based on class 4evidence.◦ Watch the bottom line◦ ‘Warm’ shock with good CO and lowSVR less common in children◦ ‘Cold’ shock with low CO and highSVR more common – some usevasodilators
Page 2: Definition of ShockInadequate oxyge
Page 5 and 6: Physiology◦ Adult Oxygen demand 1
Page 7 and 8: Compensation◦ Increase cardiac ou
Page 9 and 10: Pathophysiology of Sepsis◦ Endoth
Page 12 and 13: A brief history of septic shock tre
Page 15: The search for a magic bulletFew Ra
Page 20 and 21: esolve 28-day MortalityAdditional S
Page 22 and 23: Shock:GastroenteritisAbdo obstructi
Page 24 and 25: Role of early fluid resuscitation i
Page 26 and 27: RESULTS.34 patients (median age, 13
Page 28: 7000 critically ill adults
Page 33 and 34: Inotropes and pressors
Page 35: When to start inotropes◦ Sepsis -
Page 39 and 40: Receptor2 ndmessengerActionsα 1IP
Page 41 and 42: Adrenaline◦ α 1 , β 1 , β 2 .
Page 43 and 44: Dobutamine◦ Synthetic mixture of
Page 45 and 46: Phosphodiesterase inhibitors◦ Eno
Page 48 and 49: Vasopressin◦ Injection in humans
Page 50 and 51: Goal targeted treatment
Page 53 and 54: Largest mortality benefit of any se
Page 62: Does it work?
Page 66: Mortality associated with CV O 2sat
Page 69 and 70: Pitfalls
Page 71 and 72: Common errors (1)◦ Failure to est
Page 73 and 74: Common errors (2)◦ Inadequate flu
Page 75 and 76: Common errors (3)◦ KCl boluses◦

Inotropes and vasopressores - Cardiff PICU

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