Basic Principles of Critical Care

1. VASOACTIVE MEDICATIONS
Gradian Health Systems
Basic Principles of Critical Care
CARDIOVASCULAR SYSTEM

2. Disclaimer
Basic Principles of Critical Care Training I Vasoactive Medications
Disclaimer: Gradian Health Systems cannot provide formal recommendations or indications
regarding medical care and clinical service delivery. The tables, checklists, and other clinical
documents referenced in this training have not been validated in all settings. These documents are
intended to serve as examples only. We recognize that all clinical training content and activities
must be customized to meet the needs of each facility and its clinical staff, factoring in available
resources, practitioner skill level, and other environmental considerations.
For any questions regarding the contents or applications of this training,
please contact Gradian Health Systems:
40 W 25th St, 6th Floor
New York, NY 10010 USA
+1 212-537-0340
training@gradianhealth.org

3. Module 3
Gradian Health Systems
Basics Principles of Critical Care
Cardiovascular System

4. Module 3: Cardiovascular System
MODULE OVERVIEW
Lesson 1 I Cardiovascular System Anatomy and Physiology
Lesson 2 I Hemodynamic Monitoring
Lesson 3 I Shock
Lesson 4 I Fluid Replacement
Lesson 5 I Vasoactive Medications
Lesson 6 I Basic ECG Interpretation
Basic Principles of Critical Care Training I Vasoactive Medications

5. Components of the Gradian CCV SystemLesson 5: Vasoactive Medications
Lesson Objectives
• Describe administration routes, dosages, and side effects of common
vasoactive drugs
Basic Principles of Critical Care Training I Vasoactive Medications

6. Components of the Gradian CCV SystemLesson 5: Vasoactive Medications
Key Concepts
• Vasopressors
• Inotropes
• Vasodilators
Basic Principles of Critical Care Training I Vasoactive Medications

7. Components of the Gradian CCV SystemVasoactive Medications
What are vasoactive medications?
Vasoactive substances are very important in the management of critically ill
patients. Knowledge of the pathophysiology of shock is necessary to enable
healthcare providers to appropriately manage patients with poor perfusion.
When fluid therapy fails to restore tissue perfusion, vasopressor should be
initiated. Vasoactive drugs include:
• Norepinephrine
• Epinephrine
• Phenylephrine
• Dopamine
• Dobutamine
Basic Principles of Critical Care Training I Vasoactive Medications

8. Components of the Gradian CCV SystemVasoactive Medications
Inotropic Drugs
• Drugs that affect myocardial contractility
• Used to treat patients with heart failure
• Positive inotropes increase myocardial contractility
• Negative inotropes decrease myocardial contractility
Basic Principles of Critical Care Training I Vasoactive Medications

9. Components of the Gradian CCV SystemVasoactive Medications
Vasopressor Drugs
• Mostly used in managing distributive and cardiogenic shock
• May be used temporarily in hypovolemic shock until definitive treatment is
achieved.
• End point of treatment is arterial blood pressure with MAP > 60mmHg and
improved organ perfusion and function (e.g. urine output ≥ 0.5mg/kg)
• Precise appropriate blood pressure is patient-dependent as some require
higher blood pressures to have good tissue perfusion
Basic Principles of Critical Care Training I Vasoactive Medications

10. Components of the Gradian CCV SystemVasoactive Medications
Administration
• Should be administered through a central venous line given the potential of
causing peripheral ischemia and necrosis if extravasation occurs around the
peripheral line
• Vasoactive drugs have a short half life (effect is short)
• Sustained effect can be attained by giving a continuous infusion
• Drugs are diluted and administered using an infusion pump and dose is
titrated to the response
• Withdrawal of the drug should be gradual, and patient should be monitored
throughout
Basic Principles of Critical Care Training I Vasoactive Medications

11. Components of the Gradian CCV SystemVasoactive Medications
Norepinephrine
• Vasoconstrictor, small increase in cardiac output and stroke volume
• Dose  0.01-3.3µg/kg/min
• Side effects:
• Arrhythmias
• Peripheral ischemia
Epinephrine
• Vasoconstrictor, increases heart rate
• Dose  infusion 0.01-0.1µg/kg/min
• Side effects
• Arrhythmias
• Peripheral ischemia
Basic Principles of Critical Care Training I Vasoactive Medications

12. Components of the Gradian CCV SystemVasoactive Medications
Dopamine
• Low doses cause increases in coronary and kidney blood flow
• High dose has vasopressor effect
• Dose:
• Low dose  0.5-3µg/kg/min
• Medium dose  3-10µg/kg/min
• High dose  10-50µg/kg/min
• Side effects:
• Tachyarrhythmia
• Cardiac ischemia
Basic Principles of Critical Care Training I Vasoactive Medications

13. Components of the Gradian CCV SystemVasoactive Medications
Phenylephrine
• Vasoconstrictor
• Dose  infusion 0.04-9.1µg/kg/min.
• Side effects:
• Reflex bradycardia
Dobutamine
• Increases heart rate and cardiac contractility
• Dose  infusion 2-20µg/kg/min
• Side effects:
• Tachyarrhythmia
• Cardiac ischemia
Basic Principles of Critical Care Training I Vasoactive Medications

14. Components of the Gradian CCV SystemVasoactive Medications
Vasodilators
• Used to treat hypertension, heart failure and angina
• Reduce blood pressure by reducing systemic vascular resistance
• Examples include:
• Calcium channels blockers
• Hydralazine
• Nitroglycerine
• Beta- blockers
• Angiotensin converting enzyme inhibitors
Basic Principles of Critical Care Training I Vasoactive Medications

15. Components of the Gradian CCV SystemVasoactive Medications
Hypertension
• Defined as a SBP > 130mmHg or a DBP >80mmHg
• Hypertensive crisis is SBP > 180mmHg or DBP > 120mmHg
Basic Principles of Critical Care Training I Vasoactive Medications

16. Components of the Gradian CCV SystemLesson 5: Summary
Vasopressors are administered to critically ill patients with vasodilatory shock not
responsive to volume resuscitation, and less often in cardiogenic and
hypovolemic shock.
Basic Principles of Critical Care Training I Vasoactive Medications