Dobutamine may benefit normotensive patients with cardiac decompensation due primarily to loss of ventricular contractility or when left ventricular afterload reduction is needed. Dopamine is useful when perfusion pressure must be increased to compensate for loss of vascular tone and hypotension. The bedside nurse often must make crucial drug choices to optimize the patient's hemodynamic status. Table 2 provides an easy reference to this guideline in an algorithm. Even less experienced cardiovascular nurses have been able to apply this tool appropriately. As a standing hospital procedure, approved by our cardiovascular surgeons and related committees, it provides a legal standard whereby the nursing staff can convert from dopamine to dobutamine when the need arises.

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