Bench-to-bedside review: Inotropic drug therapy after adult cardiac surgery -- a systematic literature review.
Many adult patients require temporary inotropic support after cardiac surgery. We reviewed the literature systematically to establish, present and classify the evidence regarding choice of inotropic drugs. The available evidence, while limited in quality and scope, supports the following observations; although all beta-agonists can increase cardiac output, the best studied beta-agonist and the one with the most favourable side-effect profile appears to be dobutamine. Dobutamine and phosphodiesterase inhibitors (PDIs) are efficacious inotropic drugs for management of the low cardiac output syndrome. Dobutamine is associated with a greater incidence of tachycardia and tachyarrhythmias, whereas PDIs often require the administration of vasoconstrictors. Other catecholamines have no clear advantages over dobutamine. PDIs increase the likelihood of successful weaning from cardiopulmonary bypass as compared with placebo. There is insufficient evidence that inotropic drugs should be selected for their effects on regional perfusion. PDIs also increase flow through arterial grafts, reduce mean pulmonary artery pressure and improve right heart performance in pulmonary hypertension. Insufficient data exist to allow selection of a specific inotropic agent in preference over another in adult cardiac surgery patients. Multicentre randomized controlled trials focusing on clinical rather than physiological outcomes are needed.
Department of Intensive Care and Medicine, University of Melbourne, Austin Hospital, Melbourne, Australia.
Michael
M
Gillies
Rinaldo
R
Bellomo
Laurie
L
Doolan
Brian
B
Buxton
D002303:Cardiac Output, Low / Q000188:drug therapy*; D002316:Cardiotonic Agents / Q000145:classification / Q000627:therapeutic use*; D002395:Catecholamines / Q000627:therapeutic use*; D001026:Coronary Artery Bypass; D004280:Dobutamine / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D015300:Ventilator Weaning
D002316:Cardiotonic Agents; D002395:Catecholamines; D010726:Phosphodiesterase Inhibitors; D004280:Dobutamine