In fluid-overloaded patients with very poor renal function, a diuresis may not be possible and other modes of fluid removal such as dialysis may be required. Not all patients with pulmonary edema are fluid overloaded. Diuretics should be used judiciously in these patients because of the potential for adverse hemodynamic effects. Inotropic agents are used in patients with CHF who are hypotensive, or as an adjunct to patients with severe pulmonary edema who are not hypotensive. All inotropes are administered intravenously by constant infusion, based on patient weight and the desired clinical endpoint.
Dopamine has differing activities based on doses used.
This will improve renal perfusion and may aid in diuresis. Cardiac ischemia, dysrhythmias, and tachycardia occur more frequently as increasing doses of dopamine are used. Dobutamine is commonly used in CHF patients with pulmonary edema. Cardiac output and renal perfusion are increased. Unlike dopamine, dobutamine decreases pulmonary vascular pressures and results in minimal increases in heart rate.