Prof. John Myburgh: "Vasoactive Drugs: Facts and Fallacies"

Physiological facts:  Haemodynamics are complex and represent a teleological neurohormonal response to stress.   Defence of MAP represents the balance between the afferent and efferent circulations and the compliance of the system.  Monitoring is an aid to an overall assessment that must be considered within the clinical context and patient’s trajectory of illness.  Pharmacological facts:  Catecholamines are hormones that are administered to augment inadequate endogenous responses. Synthetic catecholamines have no established role in clinical practice. Neurohormonal supplementation strategies have limited roles and should be confined to indications established from RCTs. Non-catecholamine inodilators have not been demonstrated to improve patient-centred outcomes in critically ill patients.