Inotropic drugs in septic shock

Inotropic drugs in septic shock


  • Nutnicha Yolsiriwat Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand, 10700
  • Surat Tongyoo Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand, 10700



Septic shock, Inotropic drugs, Dobutamine, Epinephrine, Phosphodiesterase III inhibitor, Levosimendan


Septic shock is a life-threatening condition characterized by a complex underlying mechanism that requires a multidimensional treatment approach. Sepsis-induced cardiomyopathy plays a significant role in the development of multiple organ failure. The focus of this review is to determine the evidence-based data of the commonly used inotropic drugs in the management of septic shock during clinical hypoperfusion and reduced myocardial performance. Current guidelines recommend adding dobutamine to norepinephrine or using epinephrine alone in septic-induced cardiomyopathy, while suggesting against the use of levosimendan. Although dobutamine increases cardiac contractility and heart rate, it also decreases systemic vascular resistance. Epinephrine has a greater potency than dobutamine but does not demonstrate a clinical difference in hemodynamic improvement. Milrinone is preferred for cases involving pulmonary hypertension and right ventricular failure but should be avoided in the presence of renal dysfunction. Levosimendan improves cardiac performance and promotes coronary blood flow, but later evidence mentioned significant arrhythmia compared to other inotropic agents. Due to the narrow therapeutic window of these agents, precise therapeutic targets are crucial.


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How to Cite

Yolsiriwat N, Tongyoo S. Inotropic drugs in septic shock: Inotropic drugs in septic shock. Clin Crit Care [Internet]. 2024 Feb. 24 [cited 2024 Jun. 21];32(1):e240002. Available from:



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