Vasopressor resident survival guide: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{CMG}}; {{AE}} {{AZ}} | {{CMG}}; {{AE}} {{AZ}} | ||
== | ==Overview== | ||
==Management== | ==Management== | ||
{| class="wikitable" | |||
|- | |||
{ | | ||'''[[Norepinephrine]]''' || '''[[Dopamine]]''' || '''[[Vasopressin]]''' || '''[[Phenylephrine]]''' ||'''[[Dobutamine]]''' | ||
|- | |||
| '''Mechanism''' || Mainly predominant'''α1''' agonist (Vasoconstrictive) <br> *some β1 agonist (↑contractility) || *Mainly predominant '''β1''' agonist (↑ cardiac contractility) <br> * some α1 agonist(Vasoconstrictive)|| *'''V<sub></sub>1''' receptor of GIT vasculatures <br> *Antidiuretic effects || *'''Pure α1''' agonist(Vasoconstrictive) <br> *No β1 || *Predominant '''β1''' agonist (↑contractility) <br> *β2 arterial smooth muscle (Hypotensive) | |||
|- | |||
| '''Indication''' || *'''1st''' line in : <br> *'''Septic shock''' <br> *'''Cardiogenic shock''' <br>*Undifferentiated shock || 2nd line septic shock || 2nd line septic shock || '''1st''' line '''Neurogenic shock''' <BR> 3rd-4th line septic shock || *1st line '''cardiogenic shock''' <BR>* low output septic shock | |||
|- | |||
| '''Dose''' || 1-30 mcg/min <br>0.01-0.3mcg/kg/min || 2-20 mcg/min || 0.03 unit/min || 20-300 mcg/kg/min || 2.5-20 mcg/kg/min | |||
|- | |||
| '''Complications''' || Tachyarrhythmia {less β1 effect} <br>( less than Dopamine ) || Arrhythmia (more β1) || *Coronary spasm<br>*Splanchnic vasoconstriction|| Reflex bradycardia <br>(only α1) || Hypotension (β2) | |||
|- | |||
| '''Cautions''' || Arrhythmia || *'''Not in cardiogenic shock''' <br>*Arrhythmia <br> *Ischemia induced cardiotoxicity || *Ischemic heart <br> *Gut ischemia || *Bradycardia <br> *Heart block ||*Hypotension (add α1 agonist) | |||
|} | |||
==Do's== | ==Do's== | ||
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:*Always volume fluid resuscitation first | :*Always volume fluid resuscitation first | ||
:*Norepinephrine in undifferentiated shock. | :*Norepinephrine in undifferentiated shock. | ||
:*Titrate dobutamine according to clinical response slowly ( 2-20 ug/kg/min ) to avoid tachycardia (10% increase from the baseline). The benefit that dobutamine has as minimal effect on myocardial oxygen demand is lost if it is not well titrated. | |||
==Don'ts== | ==Don'ts== | ||
:* Do not start with low dose Dopamine dose to perfuse the kidney. | |||
==References== | ==References== | ||
Latest revision as of 10:53, 13 March 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Zaghw, M.D. [2]
Overview
Management
| Norepinephrine | Dopamine | Vasopressin | Phenylephrine | Dobutamine | |
| Mechanism | Mainly predominantα1 agonist (Vasoconstrictive) *some β1 agonist (↑contractility) |
*Mainly predominant β1 agonist (↑ cardiac contractility) * some α1 agonist(Vasoconstrictive) |
*V1 receptor of GIT vasculatures *Antidiuretic effects |
*Pure α1 agonist(Vasoconstrictive) *No β1 |
*Predominant β1 agonist (↑contractility) *β2 arterial smooth muscle (Hypotensive) |
| Indication | *1st line in : *Septic shock *Cardiogenic shock *Undifferentiated shock |
2nd line septic shock | 2nd line septic shock | 1st line Neurogenic shock 3rd-4th line septic shock |
*1st line cardiogenic shock * low output septic shock |
| Dose | 1-30 mcg/min 0.01-0.3mcg/kg/min |
2-20 mcg/min | 0.03 unit/min | 20-300 mcg/kg/min | 2.5-20 mcg/kg/min |
| Complications | Tachyarrhythmia {less β1 effect} ( less than Dopamine ) |
Arrhythmia (more β1) | *Coronary spasm *Splanchnic vasoconstriction |
Reflex bradycardia (only α1) |
Hypotension (β2) |
| Cautions | Arrhythmia | *Not in cardiogenic shock *Arrhythmia *Ischemia induced cardiotoxicity |
*Ischemic heart *Gut ischemia |
*Bradycardia *Heart block |
*Hypotension (add α1 agonist) |
Do's
- Assess the cause of shock
- Always volume fluid resuscitation first
- Norepinephrine in undifferentiated shock.
- Titrate dobutamine according to clinical response slowly ( 2-20 ug/kg/min ) to avoid tachycardia (10% increase from the baseline). The benefit that dobutamine has as minimal effect on myocardial oxygen demand is lost if it is not well titrated.
Don'ts
- Do not start with low dose Dopamine dose to perfuse the kidney.