Inotropic/pressor agents

Vasopressin is emerging as a potentially useful therapy in the hemodynamic support of vasodilatory septic shock. Case series and small clinical trials have reported its use in patients who remain hypotensive on vasopressors. Arginine vasopressin has little pressor activity in normal subjects but markedly increases blood pressure when sympathetic nerve function is impaired, including in septic shock. Unlike the catecholamine vasopressors, vasopressin is a direct vasoconstrictor agent and does not have inotropic or chronotropic effects. As a result, it may decrease cardiac output and hepatosplanchnic flow. In fact, studies of vasopressin in septic shock generally do not enroll patients with a cardiac index of less than 2 to 2.5 L/m per minute. 

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