Multiprofessional Critical Care Review: Adult (2023)-6: Inotropes and Vasoactive Agents in Cardiogenic Shock (Steven M. Hollenberg, MD, FACC, FAHA, FCCP)

Video Transcription

Video Summary

In this video, Dr. Steve Hollenberg discusses the use of inotropes and vasoactive agents in the management of cardiogenic shock. He begins by defining shock as inadequate perfusion and oxidation of cells, which leads to cellular and organ dysfunction and damage. Cardiogenic shock occurs when this perfusion defect results from cardiac dysfunction. Dr. Hollenberg emphasizes the importance of diagnosing and treating cardiogenic shock promptly, as it is a hemodynamic disease that can lead to mortality if left untreated. He provides an overview of the diagnostic approach, which includes a directed history and physical examination, EKG, labs, and echocardiography.<br /><br />Dr. Hollenberg highlights the significance of early coronary reperfusion in cardiogenic shock caused by an acute coronary syndrome. He discusses the role of pulmonary artery catheterization in hemodynamic assessment and management of cardiogenic shock. Dr. Hollenberg explains the different vasopressors and inotropes that can be used to support perfusion in cardiogenic shock, including norepinephrine, dopamine, epinephrine, and phenylephrine. He also mentions the use of vasopressin as an alternative vasoconstrictive agent. Dr. Hollenberg describes the complications associated with vasoactive therapies, such as tachyarrhythmias, myocardial ischemia, impaired splanchnic circulation, and immunosuppression.<br /><br />In terms of inotropic agents, Dr. Hollenberg discusses the use of dobutamine, a selective beta-1 adrenergic agonist, and milrinone, a bipyridine phosphodiesterase inhibitor. He mentions the DO-RE-MI trial, which compared milrinone with dobutamine in the treatment of cardiogenic shock and found no significant difference in outcomes. Dr. Hollenberg concludes by emphasizing the importance of individualized management based on the patient's hemodynamic profile and the need for ongoing assessment and adjustment of therapy to achieve adequate perfusion.

Keywords

cardiogenic shock

diagnosis

treatment

hemodynamic assessment

vasopressors

inotropic agents

individualized management

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