title: Effects of vasodilators on haemodynamic coherence.
abstract: Vasodilators are a potential therapeutic option for patients with persisting microcirculatory disorders despite adequate cardiac output and mean arterial pressure due to conventional haemodynamic stabilization. Venous vasodilation may decrease post-capillary venular pressure and thus increase capillary flow resulting in reduced extravasation and oedema formation. Arteriolar vasodilation may increase microvascular flow by 'opening' the microcirculation. In particular, inodilators that combine vasodilation with positive inotropy may be promising. The present article summarizes the impact of different vasodilators (nitroglycerin, calcium antagonists and prostaglandins) and inodilators (dobutamine, phosphodiesterase-inhibitors and levosimendan) on haemodynamic coherence in the treatment of shock and microvascular dysfunction. In summary, there is presently no hard evidence to recommend any vasodilator for routine practice. If used in selected patients, microvascular monitoring before and during this therapy is a pre-requisite to indicate and guide vasodilator therapy. Further clinical trials are necessary to generate more evidence in the above-mentioned patient population.
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany; Department of Anaesthesiology, University Hospital of Greifswald, Ferdinand-Sauerbruch-Strasse, 17475 Greifswald, Germany. Electronic address: fuchsc@uni-muenster.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Fuchs
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany. Electronic address: ertmer@anit.uni-muenster.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Ertmer
authors.affiliation: Department of Anaesthesiology, University Hospital of Greifswald, Ferdinand-Sauerbruch-Strasse, 17475 Greifswald, Germany. Electronic address: sebastian.rehberg@uni-greifswald.de.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Rehberg
mesh_terms: D002121:Calcium Channel Blockers / Q000494:pharmacology / Q000627:therapeutic use; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008833:Microcirculation / Q000187:drug effects*; D012769:Shock / Q000188:drug therapy / Q000503:physiopathology; D014665:Vasodilator Agents / Q000494:pharmacology* / Q000627:therapeutic use
chemical_list: D002121:Calcium Channel Blockers; D014665:Vasodilator Agents
keywords: haemodynamics; inodilators; microcirculation; shock; vasodilators