A child is receiving aggressive therapy for shock.Cardiac failure has developed.Which of the following inotropes is the most frequently used under these circumstances?

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Inotropic agents are used to increase contractility and cardiac output.Dobutamine is a beta-1 adrenergic agonist with chronotropic and inotropic actions,as well as afterload reduction.Dopamine,the most frequently used inotrope,increases renal blood flow but also has vasoconstrictive properties at high doses due to release of norepinephrine.Epinephrine is a naturally circulating neurohormone that increases contractility during stress and shock.At low dose it provides inotropy but at higher doses increases peripheral vascular tone and acts as a vasopressor.Patients with heart failure and increased systemic vascular resistance may be harmed by these higher doses unless epinephrine is combined with an inodilator or vasodilator.

A Child Is Receiving Aggressive Therapy for Shock