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Intensive Care Medicine

Erschienen in:

12.02.2016 | Review

Catecholamines for inflammatory shock: a Jekyll-and-Hyde conundrum

verfasst von: Davide Tommaso Andreis, Mervyn Singer

Erschienen in: Intensive Care Medicine | Ausgabe 9/2016

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Abstract

Catecholamines are endogenous neurosignalling mediators and hormones. They are integral in maintaining homeostasis by promptly responding to any stressor. Their synthetic equivalents are the current mainstay of treatment in shock states to counteract myocardial depression and/or vasoplegia. These phenomena are related in large part to decreased adrenoreceptor sensitivity and altered adrenergic signalling, with resultant vascular and cardiomyocyte hyporeactivity. Catecholamines are predominantly used in supraphysiological doses to overcome these pathological consequences. However, these adrenergic agents cause direct organ damage and have multiple ‘off-target’ biological effects on immune, metabolic and coagulation pathways, most of which are not monitored or recognised at the bedside. Such detrimental consequences may contribute negatively to patient outcomes. This review explores the schizophrenic ‘Jekyll-and-Hyde’ characteristics of catecholamines in critical illness, as they are both necessary for survival yet detrimental in excess. This article covers catecholamine physiology, the pleiotropic effects of catecholamines on various body systems and pathways, and potential alternatives for haemodynamic support and adrenergic modulation in the critically ill.

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Titel: Catecholamines for inflammatory shock: a Jekyll-and-Hyde conundrum
verfasst von: Davide Tommaso Andreis
Mervyn Singer
Publikationsdatum: 12.02.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 9/2016
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-016-4249-z

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