Vasopressors and Inotropes in Shock: Which One to Choose?

Hemodynamic shock is a final common pathway associated with regularly encountered emergencies including myocardial infarction, microbial sepsis, pulmonary embolism, significant trauma and anaphylaxis. Shock results in impaired tissue perfusion, cellular hypoxia, and metabolic derangements that cause cellular injury. Prompt recognition and intervention are the cornerstones of mitigating the dire consequences of shock. The maintenance of end-organ perfusion is critical to prevent irreversible organ injury and failure, and this frequently requires the use of fluid resuscitation and vasopressors and/or inotropes. Despite the widespread use of different vasopressors and inotropes in various types of shock, the understanding of their clinical effects is often inadequate and therefore, leads to erroneous therapeutic decision making. This article focusses on reviewing the underlying mechanisms of action of commonly employed vasopressors and inotropes, analysing published data on their clinical application in various types of shock, and finally, choosing the right vasopressor(s) and/or inotrope(s) in the management of various shock syndromes.