Inotropic therapy in the critically ill patient

Inotropic support is an important therapeutic modality in the intensive care unit. There are three classes of agents available to the clinician: catecholamines, bipyridines, and cardiac glycosides. Each class increases inotropy by a different mechanism and each agent has distinct physiological and pharmacological actions. It is important to understand the underlying pathophysiology involved so the appropriate inotrope can be chosen on a rational basis. Prior to and during therapy invasive hemodynamic monitoring is required to ensure proper titration of the chosen agent. If an undesirable effect ensues, therapy can then be modified.