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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…
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.
The combination of NE-dobutamine was as effective as epi in global hemodynamics, but it was safer (less arhythmias, no lactic acidosis)…
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…
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