Effects of vasodilators on haemodynamic coherence

Fuchs C, Ertmer C, Rehberg S

Abstract

Vasodilators are a potential therapeutic option for patients with persisting microcirculatory disorders despite adequate cardiac output and mean arterial pressure due to conventional haemodynamic stabilization. Venous vasodilation may decrease post-capillary venular pressure and thus increase capillary flow resulting in reduced extravasation and oedema formation. Arteriolar vasodilation may increase microvascular flow by `opening' the microcirculation. In particular, inodilators that combine vasodilation with positive inotropy may be promising. The present article summarizes the impact of different vasodilators (nitroglycerin, calcium antagonists and prostaglandins) and inodilators (dobutamine, phosphodiesterase-inhibitors and levosimendan) on haemodynamic coherence in the treatment of shock and microvascular dysfunction. In summary, there is presently no hard evidence to recommend any vasodilator for routine practice. If used in selected patients, microvascular monitoring before and during this therapy is a pre-requisite to indicate and guide vasodilator therapy. Further clinical trials are necessary to generate more evidence in the above-mentioned patient population. (C) 2016 Elsevier Ltd. All rights reserved.