Vasopressors (A Gordon)
Catecholamines for shock – equally good or equally bad? – Singer
Issue with adrenaline is that lactate becomes hard to use as a target for therapy.
Vasopressin in shock – vasoconstrictor, V1 receptor on vascular smooth muscle, binds to V2 and oxytocin receptor. Septic shock – relative vasopressin deficiency
Future trials on – angiotensin II, selepressin
Gordon – 1st line = noradrenaline. Will escalate to vasopressin (up to 0.06U/min). No dopamine.
Inotropes (A Mebazaa)
- the guidance advocates the use of lung ultrasound in the acute phase to help guide therapy
- The initial use of inopressors alone appears to be associated with a poorer prognosis compared to a regimen of inopressors and inodilators in patients who are admitted for cardiogenic shock.
Pulmonary hypertension management (S Orfanos)
Prostacyclin can reduce PVR and improve RV function but caution in LV failure. It can exacerbate V/Q mismatch leading to worsening gas exchange and hypoxaemia
Inhaled NO potent pulmonary vasodilator