Journal Article

Minimizing catecholamines and optimizing perfusion

Foulon, Pierre, De Backer, Daniel

2019

Overview

Catecholamines are used to increase cardiac output and blood pressure, aiming ultimately at restoring/improving tissue perfusion. While intuitive in its concept, this approach nevertheless implies to be effective that regional organ perfusion would increase in parallel to cardiac output or perfusion pressure and that the catecholamine does not have negative effects on the microcirculation. Inotropic agents may be considered in some conditions, but it requires prior optimization of cardiac preload. Alternative approaches would be either to minimize exposure to vasopressors, tolerating hypotension and trying to prioritize perfusion but this may be valid as long as perfusion of the organ is preserved, or to combine moderate doses of vasopressors to vasodilatory agents, especially if these are predominantly acting on the microcirculation. In this review, we will discuss the pros and cons of the use of catecholamines and alternative agents for improving tissue perfusion in septic shock.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Arterial Pressure - physiology / Blood pressure / Cardiac arrhythmia / Cardiac output / Cardiac Output - drug effects / Catecholamines / Catecholamines - adverse effects / Catecholamines - pharmacology / Catecholamines - therapeutic use / Critical care / Critical Care Medicine / Diagnosis / Dopamine / Emergency Medicine / Fluid therapy / Fluids / Humans / Inotropic agents / Intensive / Intensive care / Medicine / Medicine & Public Health / Metabolism / Microcirculation / Microcirculation - drug effects / Perfusion - methods / Perfusion - standards / Perfusion - trends / Resuscitation - methods / Resuscitation - trends / Review / Risk factors / Sepsis / Septic shock / Shock / Vasodilator agents / Vasopressor agents