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4.5 - Fluids, Inotropes and Vasopressors, Vasodilators and Anti-hypertensives

from Section 4 - Therapeutic Interventions and Organ Support

Published online by Cambridge University Press:  27 July 2023

By
Ed McIIroy
Edited by
Ned Gilbert-Kawai ,
Debashish Dutta  and
Carl Waldmann
Ned Gilbert-Kawai
Affiliation:
The Royal Liverpool Hospital
Debashish Dutta
Affiliation:
Princess Alexandra Hospital NHS Trust, Harlow
Carl Waldmann
Affiliation:
Royal Berkshire Hospital, Reading
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Summary

Key Learning Points

  1. 1. Try to avoid high chloride-containing solutions as they worsen peri-operative outcomes and, in particular, can cause acute kidney injury.

  2. 2. There is currently no evidence to support the use of albumin over crystalloids.

  3. 3. Multiple studies have found no evidence of superiority of early goal-directed therapy with dobutamine.

  4. 4. Bicarbonate will denature inotropes if infused together.

  5. 5. Beta-blocker initiation should be used cautiously in the critical care population but may have benefit in the sickest patients.

Keywords

fluid therapyinotropesvasopressorsinodilatorsanti-hypertensivesvasodilatorsbeta-blockers
Type
Chapter
Information
Intensive Care Medicine
The Essential Guide
 , pp. 477 - 491
Publisher: Cambridge University Press
Print publication year: 2021

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References

References and Further Reading

Belletti, A, Castro, ML, Silvetti, S, et al. The effect of inotropes and vasopressors on mortality: a meta-analysis of randomized clinical trials. Br J Anaesth 2015;115:656–75.CrossRefGoogle ScholarPubMed
Coppola, S, Froio, S, Chiumello, D. β-blockers in critically ill patients: from physiology to clinical evidence. Crit Care 2015;19:119.CrossRefGoogle ScholarPubMed
Finfer, S, Myburgh, J, Bellomo, R. Intravenous fluid therapy in critically ill adults. Nat Rev Nephrol 2018;14:541–57.Google ScholarPubMed
Jackson, R, Bellamy, M. Antihypertensive drugs. BJA Education 2015;15:280–5.CrossRefGoogle Scholar
Martin, G, Bassett, P. Crystalloids vs. colloids for fluid resuscitation in the intensive care unit: a systematic review and meta-analysis. J Crit Care 2019;50:144–54.CrossRefGoogle ScholarPubMed

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