Use of Inotropes and vasopressors in Septic Shock: When, Why, and How?

Septic shock, a severe and sometimes fatal condition caused by systemic infection, demands immediate and focused therapies to restore hemodynamic stability and prevent organ failure. The use of vasopressors and inotropes has become the foundation in the treatment of septic shock, with the goal of reversing the vasodilatory condition and increasing cardiac contractility. Vasopressors are an effective class of medications that cause vasoconstriction and hence increase mean arterial pressure (MAP). Norepinephrine is recommended as the first-line agent to use in septic shock. However, many medications have both vasopressor and inotropic actions, distinguishing them from inotropes, which increase heart contractility. Inotropes work by increasing cardiac contractility and thereby increasing cardiac output. Dobutamine is still the mainstay of treatment based on the latest SCCM guidelines. This review provides a comprehensive overview of the rationale, indications, doses and major side effects surrounding the administration of these pharmacological agents in septic shock. Our team extensively explored various databases regarding this subject. We concluded that the most trustworthy sources for our study were articles indexed in PubMed. We thoroughly examined these articles and synthesized the information within our review. We recommend that more trials are needed to compare the effectivity of dobutamine compared to other inotropes in the setting of septic shock as the latest guidelines are based on a shortage of randomized control trials. Also the literature should emphasize the importance of continuous hemodynamic monitoring during vasopressor therapy, highlighting the necessity for personalized changes to reach and maintain target blood pressure targets.