- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Part 2.1 Respiratory drugs
- Part 2.2 Cardiovascular drugs
- Chapter 34 Vasopressors in critical illness
- Chapter 35 Vasodilators in critical illness
- Chapter 36 Inotropic agents in critical illness
- Chapter 37 Anti-anginal agents in critical illness
- Chapter 38 Anti-arrhythmics in critical illness
- Chapter 39 Pulmonary vasodilators in critical illness
- Part 2.3 Gastrointestinal drugs
- Part 2.4 Nervous system drugs
- Part 2.5 Hormonal drugs
- Part 2.6 Haematological drugs
- Part 2.7 Antimicrobial and immunological drugs
- Part 2.8 Fluids and diuretics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care
(p. 148) Cardiovascular drugs
Vasopressors are used in various shock states to correct hypotension, aiming at restoring or improving organ and tissue perfusion. Vasopressor therapy may be associated with excessive vasoconstriction, but also metabolic and other side-effects. Hence, the ideal target for arterial pressure remains undetermined. Adrenergic agents remain the most commonly used vasopressor agents. Adrenergic agents increase arterial pressure through stimulation of alpha-adrenergic receptors. The effects of the different adrenergic agents differ mostly due to variable associated beta-adrenergic effects. Epinephrine and norepinephrine are strong and equipotent vasopressor agents. Their impact on outcome is as yet unanswered, but there is no sign that epinephrine might be associated with better outcomes. Accordingly, norepinephrine is the adrenergic agent of choice, especially in patients with cardiogenic shock. Vasopressin is a non-adrenergic vasopressor acting via V1 receptor stimulation, with weak vasopressor effects in normal conditions, but markedly increased vascular tone in shock states, especially in septic shock. Splanchnic vasoconstriction may occur. Arginine vasopressin at low doses appears to be a promising alternative to adrenergic agents, but its exact place is not yet well defined.
Access to the complete content on Oxford Medicine Online requires a subscription or purchase. Public users are able to search the site and view the abstracts for each book and chapter without a subscription.
Please subscribe or login to access full text content.
If you have purchased a print title that contains an access token, please see the token for information about how to register your code.
For questions on access or troubleshooting, please check our FAQs, and if you can't find the answer there, please contact us.
- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Part 2.1 Respiratory drugs
- Part 2.2 Cardiovascular drugs
- Chapter 34 Vasopressors in critical illness
- Chapter 35 Vasodilators in critical illness
- Chapter 36 Inotropic agents in critical illness
- Chapter 37 Anti-anginal agents in critical illness
- Chapter 38 Anti-arrhythmics in critical illness
- Chapter 39 Pulmonary vasodilators in critical illness
- Part 2.3 Gastrointestinal drugs
- Part 2.4 Nervous system drugs
- Part 2.5 Hormonal drugs
- Part 2.6 Haematological drugs
- Part 2.7 Antimicrobial and immunological drugs
- Part 2.8 Fluids and diuretics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care