Treatment of shock

Shock is a life-threatening condition, resulting from different causes, and leading to tissue hypoperfusion. Symptomatic therapy associates fluids and vasoactive agents. Vasopressor and inotropic adrenergic agents remain the most commonly used to correct hypotension and/or to increase cardiac output. These agents have different haemodynamic and metabolic profiles, but the relevance of these differences on outcome has long been challenged. Recent randomized trials have shaded some light on this issue. Dopamine and norepinephrine have been the most extensively studied. These trials raised major concerns on the use of dopamine, which was associated with tachycardia and increased arrhythmic events, and may be associated with an increased risk of death especially in the subgroup of patients with cardiogenic shock. The place of epinephrine is not well defined, this agent is associated with tachycardia, increased incidence of arrhythmic events, and undesired metabolic effects.