Scribd Logo
Upload

Welcome to Scribd!

  • 181 views

    Inotropes and Vasopressors Final

    Uploaded by

    ankur
    The practical presentation on vasopressors and inotropes from ICU point of view and credits to images providers (from Internet)

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Inotropes and Vasopressors Final

    Uploaded by

    ankur
    181 views71 pages
    The practical presentation on vasopressors and inotropes from ICU point of view and credits to images providers (from Internet)

    Original Title

    Inotropes and vasopressors final.pptx

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The practical presentation on vasopressors and inotropes from ICU point of view and credits to images providers (from Internet)

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    181 views71 pages

    Inotropes and Vasopressors Final

    Uploaded by

    ankur
    The practical presentation on vasopressors and inotropes from ICU point of view and credits to images providers (from Internet)

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 71

    Inotropes and Vasopressors

    Dr. Ankur Gupta, Intensivist.


    www.zeetings.com/ankurgupta

    Only first 25 people will be able to connect


    Inotropes and Vasopressors

    Dr. Ankur Gupta, Intensivist.


    Inotropes?

    Why do we need them?


    Shock
    Inotropes?
    Inotropes?
    • Noradrenaline
    • Adrenaline
    • Dopamine
    • Dobutamine …..
    Inotropes? Vasopressors?

    • Noradrenaline
    • Adrenaline
    • Dopamine
    • Dobutamine …..
    Inotropic effect = ↑ cardiac contractility
    Inotropes
    Chronotropic effect = ↑ Heart rate

    Vasoconstriction Vasopressors
    Commonly used in ICU Usually in OT

    Noradrenaline Phenylephrine

    Adrenaline Ephedrine

    Dopamine Isoproterenol

    Dobutamine Levosimendan

    Vasopressin Milrinone
    Receptors

    α1 β1 β2

    Dopamine Indirect
    receptors V1 mechanism
    s
    α1 β1 β2
    α1
    β1

    β2
    Commonly used in ICU Usually in OT

    Noradrenaline Phenylephrine

    Adrenaline Ephedrine

    Dopamine Isoproterenol

    Dobutamine Levosimendan

    Vasopressin Milrinone
    Noradrenaline
    (norepinephrine)
    Adrenaline
    (epinephrine)
    Low doses
    High doses
    Dopamine
    Dobutamine
    Vasopressin
    Potent vasoconstriction V1

    0.01 -0.04 units/min


    Potent vasoconstriction V1

    0.01 -0.04 units/min


    Phenylephrine
    Ephedrine Isoproterenol
    • Similar to adrenaline • non-selective β1β2
    (Less potent ) agonist

    • Used in post anaesthesia • Rarely used in ICU


    induced hypotension
    • Used usually when
    atropine fails
    • Given in boluses (has
    long half life 3 to 6 hours)
    • Causes fall in MAP and
    diastolic pressure ,
    increases systolic
    pressure.
    Ephedrine Isoproterenol
    • Similar to adrenaline • non-selective β1β2
    (Less potent ) agonist

    • Used in post anaesthesia • Rarely used in ICU


    induced hypotension
    • Used usually when
    atropine fails
    • Given in boluses (has
    long half life 3 to 6 hours)
    • Causes fall in MAP and
    diastolic pressure ,
    increases systolic
    pressure.
    When to use which agent?
    Types of SHOCK

    Cardiogenic Obstructive

    Hypovolemic Distributive
    When to use which agent?
    Doses range
    (minimum / maximum infusion rates)
    Noradrenaline

    • 2 mg ampoule
    • 2 mg in 50ml D5% = 0.04mg/ml = 40mcg/ml
    • 0.5 to 10 mcg/min = 42 mcg to 600 mcg /hr
    • 0.75 ml to 15 ml/hr (0.8ml to 15ml/hr)
    (may go to 30mcg/min = 1800 mcg/hr = 45ml/hr)
    Adrenaline

    • 1 mg ampoule
    • 1 mg in 50ml D5% = 0.02mg/ml = 20mcg/ml
    • 1 to 10 mcg/min = 60 mcg to 600mcg /hr
    • 3 ml to 30 ml/hr
    Dopamine

    Average weight 70 kg

    • 200 mg ampoule
    • 200 mg in 50ml D5% = 4 mg/ml = 4000 mcg/ml
    • Low dose 1-5 mcg/kg/min = 4200 mcg to 21000 mcg /hr = 1 to 5 ml/hr
    • Moderate dose 5-10 mcg/kg/min = 21000 mcg to 42000mcg /hr = 5 to
    10 ml/hr
    • High dose 10-20 mcg/kg/min = 42000 mcg to 2100 mcg /hr
    • 10 ml to 21 ml/hr
    Dobutamine

    Average weight 70 kg

    • 250 mg vial
    • 250mg in 50ml D5% = 5 mg/ml = 5000 mcg/ml
    • Dose 2.5 to 20 mcg/kg/min = 10500mcg to 2100 mcg /hr
    • 2 ml to 17 ml/hr
    Vasopressin

    • 20 units ampoule
    • 20 units in 50ml D5% = 0.4 units/ml
    • Dose 0.01 to 0.04 units/min = 0.6 to 2.4 units/hr
    • 1.5 ml to 6 ml/hr
    Important points
    • Keep patients relatively euvolemic before starting
    vasopressors or inotropes.
    • Don’t use dobutamine alone in cardiogenic shock if the
    patient has signs and symptoms of hypo-perfusion.
    • Don’t stop vasopressin suddenly as it may cause
    rebound hypotension.
    • Use dobutamine instead of dopamine in sepsis if
    required.
    • Complications – hypoperfusion, dysrhythmias,
    myocardial ischemia, local effects .
    • Start noradrenaline if you don’t know anything!
    From next time,
    ask whether we require an inotrope or vasopressor?

    • Inotrope
    Dopamine, Dobutamine
    • Vasopressors
    Noradrenaline , Adrenaline, Vasopressin

    Thank you

    You might also like