1-dobutamine :
dose : 2-5microgram/kg/min (titrated up to 20microgram/kg/min)
comment :inotropic(increase contractility) + vasodilator , lower blood pressure , give as individual agent as long as systolic blood pressure >90 , can used with dopamine
2-dopamine :
dose: 3-5microgram/kg/min , titrated up to 20-50microgram/kg/min as needed
comment :inotropic and vasoconstrictor , increase left ventricular end diastolic pressure and cause tachycardia , can used with dobutamine
3-noreepinephrine
dose : 2microgram/min , titrate to response
comment :inotropic and vasoconstrictor , preferred as single agent over dobutamine if SBP <70 , can use combined with dobutamine
4-epinephrine :
dose :0.1-0.5microgram/kg/min
comment : inotropic and vasoconstrictor , second tier-choice because it causes acidosis and disarrhythmia
5-milrinone:
dose :0.5microgram/kg/min
comment :inotropic , vasoconstrictor , lowers blood pressure , second tier to dobutamine
It is comparison between dopamine and dobutamine :
dopamine : natural catecholamine (precursor of NE also release NE from cardiac nerve terminals ), its mechanism : adrenergic +dopaminergic DA2,a,b agonist , effect on bp increase or sustain , effect on pulmonary capillary wedge pressure no favorable effect , effect on renal blood flow and diuresis , improve at low dose by direct action, arrhythmogenicity more but less than dobutamine , inotropic action less than dobutamine , clinical utility : shock , renal failure
dobutamine : synthetic catecholamine (does not release NE) , mechanism pure adrenergic b1>b2>a , effect on bp : increase/neutral/decrease , effect on PCWP reduce/optimise/favorable , effect on renal blood flow and diuresis , no direct action / may improve due to improved cardiac function , arrhythmogenicity : more (generally safe), inotropic action :more , consistent , clinical utility : cardiac failure ,ischemic LVF
*combination of dopamine/dobutamine infusion is very ideal in many situations but it needs diligent monitoring , dobutamine is more often used as stress echocardiography now
