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Updated: Jan 5, 2026
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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
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Vasopressor therapy in critically ill patients with shock
1Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, Canada. Jim.Russell@hli.ubc.ca.
Intensive Care Medicine
|October 25, 2019
Summary
Vasopressors are critical for treating shock, with norepinephrine as the first choice. Future research may identify biomarkers for personalized vasopressor selection and develop new agents.
Area of Science:
- Critical care medicine
- Pharmacology
- Cardiovascular physiology
Background:
- Vasopressors are used for vasodilatory shock unresponsive to fluids.
- They are also used less frequently in cardiogenic and hypovolemic shock.
Purpose of the Study:
- Review vasopressor safety and efficacy.
- Explore pathophysiology, dose-reducing agents, biomarkers, and future research directions.
Main Methods:
- Evidence quality assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE).
Main Results:
- Vasopressors act on various receptors (adrenergic, vasopressin, angiotensin, dopamine).
- Adverse effects include ischemia, hyperglycemia, and arrhythmias.
- Norepinephrine is the first-line agent for vasodilatory shock; vasopressin or epinephrine may be added if refractory.
- Corticosteroids showed mortality benefit in some trials.
- Angiotensin II is useful in profound hypotension; dopamine is reserved for bradycardic patients.
Conclusions:
- Norepinephrine is the primary vasopressor, with vasopressin or epinephrine as alternatives.
- Angiotensin II and dopamine have specific, limited indications.
- Future directions include predictive biomarkers and novel vasopressor development.
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