Multiprofessional Critical Care Review: Pediatric 2024 (MCCRCP24ON)-Vasoactive Agents

Vasoactive Agents

Pdf Summary

The document provides a detailed overview of the use of vasoactive agents in the Intensive Care Unit (ICU), particularly for managing myocardial or circulatory dysfunction. Authored by Dr. Ravi R. Thiagarajan, the content draws from the Pediatric Multiprofessional Critical Care Review Course and comprehensively addresses various aspects of vasoactive agents.<br /><br />Key points discussed include the classification and mechanism of action of these agents, which operate through adrenergic receptors and may also have direct intracellular effects. The agents impact various physiological parameters such as myocardial contractility (inotropes), heart rate (chronotropes), systemic vascular resistance (vasoconstrictors and vasodilators), and diastolic relaxation (lusitropes).<br /><br />Adrenergic receptors play a crucial role, with different receptor types (α1, β1, β2, DA1, DA2) located in specific tissues affecting vasoconstriction, vasodilation, and other responses. The document lists common vasoactive agents such as phenylephrine, norepinephrine, epinephrine, dopamine, dobutamine, isoproterenol, vasopressin, and milrinone, detailing their receptor affinities and consequent physiological actions.<br /><br />Additionally, other agents like sodium nitroprusside, a nitric oxide donor that reduces calcium influx, and nicardipine, a calcium channel blocker, are discussed. Both agents function primarily as vasodilators but come with potential risks like methemoglobinemia and thiocyanide toxicity for sodium nitroprusside, and intrapulmonary shunt and increased intracranial pressure (ICP) for nicardipine.<br /><br />The document concludes by emphasizing the need to understand the mechanisms of action of these agents to select the appropriate one based on the patient's underlying disease and physiological status. This summary knowledge is crucial for healthcare professionals managing critical care scenarios.

Keywords

vasoactive agents

ICU

myocardial dysfunction

circulatory dysfunction

adrenergic receptors

inotropes

vasoconstrictors

vasodilators

Dr. Ravi R. Thiagarajan

critical care

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