Cardiovascular Critical Care I
Vasoactives
Dopa
α1
β1
β2
Other
Mechanism
HR
CVP
CO
SVR
PVR
Vasodilators
Nitroglycerin
cGMP
↔ or ↑
↓
↔ or ↑
↔ or ↓
↔ or ↓
Nitroprusside
cGMP
↔ or ↑
↓
↔ or ↑
↓
↓
Nitric oxide
(inhaled)
cGMP
N/A
↔
↔ or ↑
↔
↓
Epoprostenol
(inhaled)
cAMP
N/A
↔
↔ or ↑
↔
↓
aHigh doses associated with increasing α1 activity.
bNormal half-life is 2.5 hours, but drug is eliminated renally. Loading dose rarely used in routine management because of hypotension.
AMP = cyclic adenosine monophosphate; AT1 = angiotensin II type 1; cGMP = cyclic guanosine monophosphate; CVP = central venous pressure; HR = heart rate;
N/A = not applicable; PDE3 = phosphodiesterase type 3; PVR = pulmonary vascular resistance; SVR = systemic vascular resistance. Information from: Br J Pharmacol
2011;24:44-60.
Sustained hypotension unresponsive to fluid administration alone (systolic blood pressure [SBP] less
than 90 mm Hg for at least 30 minutes) (Cardiol Clin 2013;4:567-80)
Signs and symptoms of malperfusion in the setting of volume overload and elevated cardiac filling
pressures (e.g., pulmonary capillary wedge pressure greater than 18 mm Hg)
Stage A – at risk. These patients are not in shock but are at risk of future development.
without hypoperfusion.
Stage C – classic. These patients have evidence of hypotension and hypoperfusion requiring intervention,
including vasoactive therapies and mechanical circulatory support.
Stage D – deteriorating. These patients are those in stage C who are getting worse despite attempts to
restore optimal hemodynamics.
Stage E – extremis. These patients are experiencing cardiac arrest with ongoing cardiopulmonary
resuscitation or extracorporeal membrane oxygenation (ECMO).