par De Backer, Daniel 
;Foulon, Pierre
Référence Cardiopulmonary Monitoring: Basic Physiology, Tools, and Bedside Management for the Critically III, Springer International Publishing, page (751-758)
Publication Publié, 2021-01
;Foulon, Pierre Référence Cardiopulmonary Monitoring: Basic Physiology, Tools, and Bedside Management for the Critically III, Springer International Publishing, page (751-758)
Publication Publié, 2021-01
Partie d'ouvrage collectif
| Résumé : | Vasopressors are an essential part of our resuscitation strategies. The rationale for their use is the preservation of perfusion pressure to the organs. The target blood pressure should be individually estimated and indices of organ perfusion and the risks of adverse events associated with vasopressor therapy should be taken into account. Specificities of patients with cardio-respiratory failure should also be taken into account. The effects of vasopressors on left ventricular function are very variable. In patients with severely impaired cardiac function, vasopressors may further compromise cardiac function by increasing left ventricular afterload. In patients with relatively preserved cardiac function, vasopressors may increase cardiac output and even contractility, but this effect is expected to occur mostly at their initiation and, later on, the impact of the increase in left ventricular afterload may still predominate. In hypotensive patients with right heart failure, vasopressor initiation is crucial and aims at restoring right coronary perfusion. Norepinephrine is considered to be the first-line vasopressor agent. Vasopressin derivatives may be considered in patients with distributive shock and especially in patients with right heart failure. Angiotensin appears to be promising but more data are required to understand its position in the management of patients with shock. |
