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Treatment of Circulatory ShockUse of Sympathomimetic and Related Vasoactive Agents
Max H. Weil, MD, PhD;
Herbert Shubin, MD;
Richard Carlson, MD, PhD
JAMA. 1975;231(12):1280-1286.
Abstract
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Reduction of effective blood flow represents the primary disturbance accounting for circulatory shock. Four categories of circulatory shock are identified: cardiogenic, hypovolemic, distributive, and obstructive. The pharmacology and clinical implications for treatment of shock with vasoactive drugs are reviewed in this context.
Except for epinephrine, when it is used for treatment of anaphylactic shock, there is no specific indication for the routine use of  - or β-adrenergic receptor agonists. These agents may increase blood pressure or cardiac output, but nutritive flow is not necessarily improved. Comparable limitations are observed with -adrenergic receptor blocking agents. However, selective effects on the myocardium and on the resistance, exchange, and capacitance vessels may be advantageous as an interim and complementary measure. Since vasoactive drugs frequently intensify the fundamental defect accounting for perfusion failure, their selective rather than routine employment is mandatory.
(JAMA 231:1280-1286, 1975)
Author Affiliations
From the Center for the Critically III, and the Shock Research Unit, University of Southern California School of Medicine, the Los Angeles County/USC Medical Center, and the Hollywood Presbyterian Medical Center, Los Angeles.
Footnotes
Reprint requests to Center for the Critically III, University of Southern California School of Medicine, 1300 N Vermont Ave, Los Angeles, CA 90027 (Dr. Weil).
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