Lessons from the ICU: Choosing the right vasopressor

Abstract

Vasopressors are extensively used to provide cardiovascular support in the critically ill by increasing vascular tone and therefore mean arterial pressure. There are a number of indications for vasopressors in critical care, but their predominant role is in treating hypotension associated with circulatory shock. This chapter presents the key principles underlying the choice and use of vasopressors in clinical practice, focussing on practical implications for the clinician. The main adrenergic and non-adrenergic agents currently available are discussed in detail, as well as novel candidates emerging alongside them. For each class and agent, the relevant pharmacology, clinical indications, advantages and pitfalls are described, supported by up-to-date medical evidence.