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We' ll continue our vasoactive medication review with our old frined dobutamine! #chestcritcare
It is primarily a Beta-1 agonist, but it acts on Beta2 and alpha as well, making it a great inotrope, and also an ok vasodilator (in high doses alha agonism kicks in, and some vasoconstriction may occur

cfrjournal.com/articles/Inotr…
Dobutamine is used in the treatment of cardiogenic shock, it improves symptoms, but it has been associated with increased in-hospital mortality and future HF readmissions. It is also associated with arrhythmias and it has been rarely associated with eosinophilic myocarditis.
pubmed.ncbi.nlm.nih.gov/26123415/

pubmed.ncbi.nlm.nih.gov/15081466/
The combination of NE-dobutamine was as effective as epi in global hemodynamics, but it was safer (less arhythmias, no lactic acidosis)

journals.lww.com/ccmjournal/Ful…
So dobutamine is a good choice for cardiogenic shock, but it is highly arrhythmogenic and has a more potent inotropic effect than vasoactive (dilation in "usual" doses and constriction in high doses). #chestcritcare
For a phenomenal, physiology-based approach to cardiogenic shock, please refer to this paper published @accpchest #chestcritcare #pccm #ccm

journal.chestnet.org/action/showPdf…
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CHEST Critical Care NetWork
@CHESTCritCare
Continuing the vasoactive meds week, we will talk about dopamine. It is a precursor of norepinephrine, inducing its release. There are dopamine receptors in the renal, splanchnic, coronary and cerebral vascular beds; stimulation of these receptors cause vasodilation. #critcare
Again, since our historical "nerdiness" was so well received, this is one of the first papers that talked about dopamin in shock: pubmed.ncbi.nlm.nih.gov/1563/#:~:text=…
And this is their conclusion:"Because dopamine increases myocardial contractility, selectively redistributes perfusion to essential viscera and allows a pharmacologic titration of effect, it is a logical first-choice catecholamine for treatment of shock and refractory HF."
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CHEST Critical Care NetWork
@CHESTCritCare
Today is phenylephrine day everyone! Thank u for following our shock/vasoactive drugs week so far. Phenylephrine is a pure alpha-adrenergic agonist, resulting in vasoconstriction with minimal ino/chronotropy. Midodrine is its oral equivalent. Main side effect: reflex bradycardia
Phenyl is useful in septic shock and for anesthesia-induced hypotension ncbi.nlm.nih.gov/pmc/articles/P…

ncbi.nlm.nih.gov/pmc/articles/P…

ncbi.nlm.nih.gov/pmc/articles/P…
pubmed.ncbi.nlm.nih.gov/1935160/
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CHEST Critical Care NetWork
@CHESTCritCare
Thank you everyone for following our vasoactive meds week so far. Today it is Epinephrine's day. Since we had great feedback on our historical nerdy side, we will start with some extra history on epinephrine:
“asthma is immediately cured in situations of either sudden alarm or violent fleeting excitements”, this is believed to be the first description of the therapeutic effect of endogenous epinephrine. thelancet.com/journals/lanre…
Epi has potent beta-1 adrenergic receptor activity and moderate beta-2 and alpha-1 adrenergic receptor effects. Clinically, low doses of epinephrine increase CO because of the beta-1 adrenergic receptor inotropic and chronotropic effects...
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