What are inotropes used in ICU?

Intensive care patients often require inotropic support to stabilise circulation and to optimise oxygen supply. In this context, the catecholamines norepinephrine (noradrenaline), epinephrine (adrenaline), dopamine and dobutamine are still the mainstay of therapy.

What is inotropic therapy used for?

Inotropic therapy with milrinone or dobutamine can be used in chronic heart failure patients as a bridge to recovery from an acute hemodynamically compromised state and in advanced stage heart failure patients awaiting advanced heart failure therapies, such as mechanical circulatory support and heart transplant.

How are inotropes administered?

Inotropes should be administered via a central venous catheter. Drug administration procedures should be followed stringently.

What are the 4 inotropic medications generally in use?

Each of the major medications will be discussed briefly.

• The major vasopressors include phenylephrine, norepinephrine, epinephrine, and vasopressin.
• The American College of Critical Care Medicine (ACCM) guidelines recognize that a MAP of 60 to 65 mm Hg is required to perfuse organs.

When are inotropes given?

This medicine is usually given to patients with congestive heart failure or cardiomyopathy. These medicines may also be given to patients who have had a recent heart attack. In some cases, inotropes are given to patients whose hearts have been weakened after heart surgery (in cases of cardiogenic shock).

Which drugs are inotropes?

Inotropic drug list

• Epinephrine (Adrenalin® or Auvi-Q®).
• Norepinephrine (Levophed® or Levarterenol®).
• Dopamine.
• Dobutamine.
• Levosimendan.
• Milrinone.
• Digoxin (Cardoxin® or Lanoxin®).
• Amrinone.

When do you use inotrope for heart failure?

Inotropes increase cardiac output mainly by enhancing cardiac contractility. Inotropes indicated for heart failure are beta-agonists, milrinone, levosimendan. Inotropes should only be used in low-output acute or advanced heart failure. Identifying patients with low-output heart failure is often challenging.

What are examples of inotropes?

Inotropic Agents

• amrinone.
• digoxin.
• dobutamine.
• dopamine.
• inamrinone.
• Intropin.
• Lanoxin.
• milrinone.

Why are inotropes given centrally?

For this reason, almost all inotropic agents should be administered through an infusion controller via a central venous line. Such practice avoids possible leakage in a peripheral line with subsequent vasoconstriction and peripheral ischemia.

Do inotropes increase heart rate?

Positive inotropes help the heart pump more blood with fewer heartbeats. This means that although the heart beats less, it also beats with more force to meet the oxygen demands of your body.

What is an inotropic infusion?

Inotropic therapy is an infusion of medication that changes your heart’s calcium level, which helps make your heart muscle contract.

When do you give inotropes?

Inotropes are indicated in acute conditions where there is low cardiac output (CO),such as cardiogenic shock following myocardial infarction, acute decompensated heart failure and low CO states after cardiac surgery.

Why do we give inotropes?

Inotropes aim at increasing cardiac output by enhancing cardiac contractility. They constitute the third pharmacological pillar in the treatment of patients with decompensated heart failure, the other two being diuretics and vasodilators.

Which medication is inotropic?

The principal inotropic agents are dopamine, dobutamine, inamrinone (formerly amrinone), milrinone, dopexamine, and digoxin. In patients with hypotension who present with CHF, dopamine and dobutamine usually are employed.

Can inotropes given in peripheral line?

Of the commonly prescribed inotropic agents, dobutamine (increases cardiac output and reduces afterload) may be given via a peripheral line while the patient is closely monitored. Such therapy is particularly useful in the treatment of patients with severe heart failure.

Why are inotropes used in heart failure?

When are inotropes used in heart failure?

Which lumen is used for inotropes?

Inotropes should be connected to a dedicated CVC lumen and no bolus medication is to be given via this lumen. In the case of profound hypotension a bolus of a continuous adrenaline infusion or a 1:100,000 solution may be given as per the flow chart below.

When should you start inotropes?

Inotropes are indicated in acute conditions where there is low cardiac output (CO),such as cardiogenic shock following myocardial infarction, acute decompensated heart failure and low CO states after cardiac surgery. Reduced CO leads to tissue hypoperfusion and subsequent hypoxia.

What are the inotropic medications used in intensive care?

Intensive care patients often require inotropic support to stabilise circulation and to optimise oxygen supply. In this context, the catecholamines norepinephrine (noradrenaline), epinephrine (adrenaline), dopamine and dobutamine are still the mainstay of therapy.

Can inotropic infusions be administered at home?

On the basis of the inpatient experiences, inotropic infusions have also been administered intermittently at home or at outpatient infusion clinics on a regular schedule. 5,11–13 Improvement in symptoms and reduction in rehospitalization have been demonstrated for some patients after enrollment in these programs.

What is the purpose of continuous inotropic therapy?

For patients considered dependent, continuous inotropic therapy is then used to serve as a “bridge” to arrival at a destination such as transplantation or the end of life. Prolonged use requires insertion of an indwelling intravenous line, usually linked to a wearable drug-infusion pump.

Are outpatient inotrope infusions effective at the end of life?

The use of continuous outpatient inotropic infusions at the end of life is increasing, even at heart failure centers previously opposed to the practice. This reflects an evolving population who survive long enough to develop refractory symptoms.