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Use of Vasopressors and Inotropes in the Pharmacotherapy of Shock

Learning Objectives:

On completion of the chapter, the reader will be able to:

1. Apply the principles of cardiopulmonary physiology to hemodynamic monitoring of the septic shock patient.

2. Compare and contrast methods for assessing intravascular volume status of the septic shock patients.

3. List factors affecting blood pressure and cardiac output.

4. Discuss the physiologic basis for gastric tonometry as a measure of regional perfusion in the critically ill.

5. Describe the oxygen delivery and consumption relationship as it applies to critically ill patients.

6. Describe the effects of catecholamine vasopressors and inotropes on adrenergic receptors and vasopressin on vasopressin receptors and relate these effects to clinical end points.

7. Compare and contrast vasopressors, inotropes, and vasopressin in terms of clinical end points and adverse effects.

8. Describe the concepts of early goal-directed therapy as they apply to resuscitation of septic shock.

9. Describe the roles of vasopressin and corticosteroids in septic shock.

10. Formulate a monitoring plan to assess the effects of catecholamine vasopressors, inotropes, and vasopressin on global and regional hemodynamics.

11. Develop a protocol for optimizing oxygen delivery in hypotensive septic shock patients.

12. Evaluate the level of evidence for treatment recommendations for the management of severe sepsis or septic shock.

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