Vasopressors and inotropes
Dobutamine (Dobutrex) drip
Dobutrex
Dosing
| Start | 2–5 mcg/kg/min (label starts 0.5–1) |
|---|---|
| Titrate | By response every 10–30 minutes |
| Maximum | 20 mcg/kg/min (rarely 40) |
| Common bags | 250 mg in 250 mL (1 mg/mL); 500 mg in 250 mL (2 mg/mL) |
| Dose units | mcg/kg/min |
Line and administration
- Peripheral or central
Watch for
- Tachycardia and ectopy
- Hypotension (inodilator): MAP first, then dobutamine
Dobutamine: full drug monographIndications, mechanism, pharmacokinetics, cautions and every dose the app lists.
In the one-pagers
- Vasopressors and InotropesReceptors and effects: Dobutamine: β1 > β2: ↑ / ↑↑ / ↓
- ACS and STEMIMechanical complications, RV infarction and shock: RV infarction accompanies up to 40% of inferior STEMIs (LITFL). V4R elevation marked 31% vs 6% in-hospital mortality (Zehender 1993) and fades within 10 h in half of patients. Expect hypotension, clear lungs and raised JVP, with RAP ≥10 mm Hg close to the wedge (RAP:PCWP ≥0.8). Reperfuse; no nitrates or diuretics; fluid in 250–500 mL steps while o
- Obstetric EmergenciesAmniotic fluid embolism: Right heart failure: echo, 500 mL boluses with reassessment, norepinephrine, adding dobutamine 2.5–5 or milrinone 0.25–0.75 mcg/kg/min
- Pulmonary EmbolismSupporting the failing RV: Dobutamine for low output once MAP holds; inhaled NO or epoprostenol as a bridge
- Shock Types at a GlanceCardiogenic shock: LV, RV, SCAI and MCS escalation: RV shock follows RV infarct (inferior STEMI, ST elevation in V4R), PE, ARDS, pulmonary hypertension and LVAD implantation. The dilated RV pushes the septum into the LV, so LV filling falls even with normal LV muscle. Give fluid until CVP is about 10–15 mm Hg, then stop; keep AV synchrony (pace heart block); avoid hypoxemia, hypercapnia, acidosis
- LVAD BasicsSelection, implant and the early postoperative course: The first week is about the right ventricle. Unloading pulls the septum leftward and removes its help to RV contraction while pump flow raises venous return to an RV still facing high pulmonary pressures; it dilates, the LV under-fills, and flow and PI fall with a high CVP. INTERMACS counts right heart failure as needing an RVAD, prolonged inh
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Other vasopressors and inotropes
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For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against your local protocols and medical direction, the bag label and your pump.