Inotropes and Vasopressors

Vasoactive drugs such as inotropes and vasopressors are commonly used to correct hemodynamic abnormalities in patients with circulatory failure. Conventionally, vasoactive drugs have been classified based on their relative effects on the heart (inotropic effects) and vascular tone (vasoconstriction) into inotropes and vasopressors, respectively. Inotropes have been sub-classified into calcitropes, myotropes and mitotropes based on their mechanism of action. However, in practice most inotropes in clinical use in the intensive care unit are calcitropes, and sub-classified into inodilators and inoconstrictors, based on their concomitant vasodilatation and vasoconstriction effects. Norepinephrine is the most commonly used drug for vasopressor effects in circulatory shock, but there is growing interests in non-catecholaminergic vasopressors, including vasopressin and angiotensin II. Data on the use of vasoactive drugs, and vasopressors in particular in cardiogenic shock are limited. This chapter provides an overview on the commonly used vasoactive drugs, and practical use of vasoactive drugs in relation to circulatory shock.