(March 28, 2023)
Adult dose for cardiogenic shock (6, 8)
Inotropes, especially those with adrenergic mechanisms, can cause sinus tachycardia, increase ventricular rate in patients with AF, may induce myocardial ischaemia and arrhythmias, and increase mortality (6).
Dobutamine: first-line inodilator?
No solid evidence supports one drug over another to be recommended as the first-line inotrope for cardiogenic shock. From a pathophysiological point of view, their mechanism of action should guide as an initial preference depending on the clinical context (eg. beta-blocker toxicity).
Levy B, Perez P, Perny J, Thivilier C, Gerard A. Comparison of norepinephrine-dobutamine to epinephrine for hemodynamics, lactate metabolism, and organ function variables in cardiogenic shock. A prospective, randomized pilot study. Crit Care Med. 2011;39(3):450-455. doi:10.1097/CCM.0b013e3181ffe0eb