Shock Syndromes I
DA
α1
β1
β2
Other
Mechanism
HR
CVP
CO
SVR
PVR
Vasopressors
Dopamineb
< 5 mcg/kg/min
++++
— or ↑
— or
↑
— or
↑
↔
↔
Dopamineb
5–15 mcg/kg/min
+
++++
+
↑
— or
↑
↑
— or ↑
— or
↑
Dopamineb
> 15 mcg/kg/min
++++
++
++
— or ↑
— or
↑
↑
↑
↑
Epinephrinec
< 5–10 mcg/min
++
++++
+++
↑
— or
↑
↑
↑
↑
Epinephrinec
> 5–10 mcg/min
++++
+++
+
↑
— or
↑
↑
↑
↑
Norepinephrine
++++
+++
+
↓ or —
or ↑
— or
↑
— or
↑
↑
↑
Phenylephrine
+++
— or ↓
— or
↑
— or
↓
↑
↑
Vasopressin
N/A
V1R and V2R
agonism
— or ↓
— or
↑
↔
↑
— or
↓
Angiotensin II
N/A
AT-R1 and
AT-R2 agonism
↑
— or
↑
↔
↑
?
Inotropes
Dobutamine
+
++++
++
↑
— or
↓
↑
— or
↓
— or
↓
Isoproterenol
++++
++++
↑
— or
↓
↑
— or
↓
— or
↓
Levosimendan
N/A
Ca2+
sensitization and
KATP activation
↔
— or
↓
↑
↓
↓
Milrinoned
N/A
PDE3
inhibition
— or ↑
— or
↓
↑
↓
↓
aReceptor activity ranges from no activity (0) to maximal (++++) activity.
bDopamine has dose-dependent effects. At lower doses (< 5 mcg/kg/min), activity at dopamine receptors predominates. At moderate doses (5–15 mcg/kg/min), β1 effects
predominate, and at doses > 15 mcg/kg/min, α1 effects predominate. However, there is overlap in these effects, and these dose ranges are not exact.
cEpinephrine has dose-dependent effects. At lower doses (˂ 5–10 mcg/min), activity at β receptors predominates. At higher doses (typically ˃ 10 mcg/min), α1 receptor
activity becomes more prominent. However, there is overlap in these effects, and these dose ranges are not exact.
dNormal half-life is 2.5 hr, but milrinone is eliminated renally. Loading dose rarely used in routine management.
AT-R1 = angiotensin receptor type 1; AT-R2 = angiotensin receptor type 2; DA = dopaminergic; KATP = adenosine triphosphate-sensitive potassium channels; N/A =
not applicable; PDE3 = phosphodiesterase type 3; V1R = vasopressin receptor type 1; V2R = vasopressin receptor type 2; ? = unclear.
Information from: Bangash MN, Kong ML, Pearse RM. Use of inotropes and vasopressor agents in critically ill patients. Br J Pharmacol 2012;165:2015-33; Hollenberg
shock. Shock 2017;47:560-6; Chawla LS, Busse L, Brasha-Mitchell E, et al. Intravenous angiotensin II for the treatment of high-output shock (ATHOS trial): a pilot