Key messages

• Vasodilators are the treatment of choice for hypertensive emergencies and cardiogenic pulmonary edema.

• Vasodilating therapy may alleviate pulmonary hypertension, but often at the cost of an increased venous admixture of oxygen in the lungs.

• Vasodilators usually do not benefit the patient in non-cardiogenic shock.

• Invasive monitoring via a pulmonary artery catheter may be indicated for proper institution and guidance of vasodilator therapy. Introduction

In some conditions requiring intensive care, vasodilator drugs may play a major therapeutic role. These conditions include hypertensive emergencies and primary and secondary pulmonary hypertension. Apart from their blood-pressure-lowering effects, vasodilator drugs are also used to unload the heart, for instance in the case of acute left heart failure or the low cardiac output syndrome associated with various types of circulatory shock. The intravenous route for administration of vasodilators is preferred for treatment in the intensive care unit (ICU), as it allows small starting doses which can be increased over relatively short periods of time guided by the hemodynamic response and which can be followed by continuous maintenance dosing provided that the drugs used have a relatively short half-life. In contrast with the generally prolonged action of orally administered drugs, the intravenous route allows blood pressure to rise rapidly once the infusion has been stopped. Nevertheless, oral therapy is indicated when the patient is prepared for transfer to the general ward. There are large differences between individuals and drugs in dose-response relationships. As a rule, the vasodilating effect is greatest in patients with severe vasoconstriction.

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