title: [Catecholamines: pro and contra].
abstract: BACKGROUND
  Catecholamines with vasopressor and inotropic effects are commonly used in intensive care medicine. The aim of this review is to explain some of the physiologic actions on which a catecholamine therapy is based, but also to elucidate the risks which are associated with an uncritical and excessive use of these drugs.
  
  
  RESULTS
  Emphasis is placed on the myocardial damage triggered by adrenergic overstimulation. There is considerable evidence that in conditions of severe heart failure, myocardial ischemia as well as cardiogenic and septic shock especially the use of catecholamines with predominant β-adrenergic effects (epinephrine, dobutamine, dopamine) can have a negative clinical impact. A simple cardiac risk marker might be a tachycardia.
  Vasopressor therapy with norepinephrine, based on individually applied perfusion parameters (e.g., urine output, lactate), however, seems justified in many conditions of shock and hemodynamic instability during deep analgosedation. In terms of a cardioprotective therapy, the administration of catecholamines, however, should always be reevaluated and titrated to the minimum deemed necessary.
authors: Internistische Intensivstation, Department für Innere Medizin, Universitätsklinikum Tübingen, Otfried-Müller Str. 10, 72076, Tübingen, Deutschland. reimer.riessen@med.uni-tuebingen.de.
authors: R
authors: R
authors: Riessen
authors: Interdisziplinäre Notaufnahme, Marienhospital Stuttgart, Stuttgart, Deutschland.
authors: O
authors: O
authors: Tschritter
authors: Innere Medizin, St.-Antonius-Hospital, Eschweiler, Deutschland.
authors: U
authors: U
authors: Janssens
authors: Internistische Intensivstation, Department für Innere Medizin, Universitätsklinikum Tübingen, Otfried-Müller Str. 10, 72076, Tübingen, Deutschland.
authors: M
authors: M
authors: Haap
mesh_terms: D002316:Cardiotonic Agents / Q000627:therapeutic use; D002395:Catecholamines / Q000627:therapeutic use*; D016292:Procedural Sedation / Q000379:methods; D000075202:Contraindications; D003422:Critical Care / Q000379:methods*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D012307:Risk Factors; D012769:Shock / Q000188:drug therapy; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D002316:Cardiotonic Agents; D002395:Catecholamines; D014662:Vasoconstrictor Agents
keywords: Biogenic monoamines; Cardiomyopathy; Intensive care medicine; Sepsis; Shock