Vasopressor Support in Septic Shock - Introduction to General Medicine - Lecture Slides, Slides of Medicine

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International Guidelines – Sepsis

Vasopressor Support in Septic Shock

Vasopressor Support in Septic Shock

Below a certain MAP, autoregulation is lost and perfusion becomes linearly depend on pressure

Vasopressor Support in Septic Shock

• Use either Norepinephrine (NE) or Dopamin (Dopa) as the first choice vasopressor agent to correct hypotension
• Epinephrine (Epi), Phenylephrine or vasopressin should not be administered as the initial vasopressor in septic shock

Evidence C-

Vasopressor Support in Septic Shock

Vasopressin in Sepsis

• In physiologic doses: 0.01-0.04 U/min, is synergistic with exogenous cathecholamines, yielding a pressor response without evidence of organ hypoperfussion
• In pharmacologic doses: >0.04 U/min, the vasopressor effect is associated with vasoconstriction of renal, mesenteric, pulmonary and coronary vasculature

Vasopressor Support in Septic Shock

• Vasopressin 0.03 – 0.04 U/min may be added to NE, to raise BP in patients with refractory Septic Shock

Evidence C-

Inotropic Support in Septic Shock

Inotropic Support in Septic Shock

• Consider Dobutamine as first choice Inotrope for patient with measured or suspected low cardiac output, in the presence of adequate left ventricular filling pressure and adequate MAP

Evidence 1-C