Vasopressor resident survival guide: Difference between revisions

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__NOTOC__
__NOTOC__
{{Sepsis}}
{{CMG}}; {{AE}} {{AZ}}
{{CMG}}; {{AE}} {{AZ}}


==Definition==
==Overview==
 
==Causes==
 
===Life Threatening Causes===
 
===Common Causes===
 
 
===Prognosis===
 


==Management==
==Management==
 
{| class="wikitable"
{{Family tree/start}}
|-
{{Family tree | | | | | | | | | | | | |A01 | | | | | | | |boxstyle_A01=BACKGROUND:SALMON|A01= '''Vasopressors'''}}
| ||'''[[Norepinephrine]]''' || '''[[Dopamine]]''' || '''[[Vasopressin]]''' || '''[[Phenylephrine]]''' ||'''[[Dobutamine]]'''
{{Family tree | | | | | | | | | | | | | |!| | | | | | | | }}
|-
{{Family tree | | | | | |,|-|-|-|v|-|-|-|+|-|-|-|v|-|-|-|.| | |}}
| '''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)
{{Family tree | | | | | B01 | | B02 | | B03 | | B04 | | B05 | |B01='''[[Norepinephrine]]''' |B02='''[[Dopamine]]''' |B03='''[[Vasopressin]]''' |B04='''[[Phenylephrine]]'''|B05='''[[Dobutamine]]''' }}
|-
{{Family tree | | | | | |!| | | |!| | | |!| | | |!| | | |!| | |}}
| '''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
{{Family tree | C01 | | C02 | | C03 | | C04 | | C05 | | C06 | |C01= '''Mechanism''' |C02= *Mainly predominant'''α1''' agonist (Vasoconstrictive) <br> *some β1 agonist (↑contractility) |C03= *Mainly predominant '''β1''' agonist (↑ cardiac contractility) <br> * some α1 agonist(Vasoconstrictive)|C04= *'''V<sub></sub>1''' receptor of GIT vasculatures <br> *Antidiuretic effects |C05= *'''Pure α1''' agonist(Vasoconstrictive) <br> *No β1 |C06= *Predominant '''β1''' agonist (↑contractility) <br> *β2 arterial smooth muscle (Hypotensive) }}
|-
{{Family tree | | | | | |!| | | |!| | | |!| | | |!| | | |!| | |}}
| '''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
{{Family tree | D01 | | D02 | | D03 | | D04 | | D05 | | D06 | |D01= '''Indication''' |D02= *'''1st''' line in : <br> *'''Septic shock''' <br> *'''Cardiogenic shock''' <br>*Undifferentiated shock |D03= 2nd line septic shock |D04= 2nd line septic shock |D05= '''1st''' line '''Neurogenic shock''' <BR> 3rd-4th line septic shock |D06= *1st line '''cardiogenic shock''' <BR>* low output septic shock }}
|-
{{Family tree | | | | | |!| | | |!| | | |!| | | |!| | | |!| | |}}
| '''Complications''' || Tachyarrhythmia {less β1 effect} <br>( less than Dopamine ) || Arrhythmia (more β1) || *Coronary spasm<br>*Splanchnic vasoconstriction|| Reflex bradycardia <br>(only α1) || Hypotension (β2)
{{Family tree | E01 | | E02 | | E03 | | E04 | | E05 | | E06 | |E01= '''Dose''' |E02= 1-30 mcg/kg/min |E03= 1-20 mcg/min |E04= 0.03 unit/min |E05= 20-300 mcg/kg/min |E06= 2.5-20 mcg/kg/min }}
|-
{{Family tree | | | | | |!| | | |!| | | |!| | | |!| | | |!| | |}}
| '''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)
{{Family tree | F01 | | F02 | | F03 | | F04 | | F05 | | F06 | |F01= '''Complications''' |F02= Tachyarrhythmia {less β1 effect} <br>( less than Dopamine ) |F03= Arrhythmia (more β1)   |F04= *Coronary spasm<br>*Splanchnic vasoconstriction|F05= Reflex bradycardia <br>(only α1) |F06= Hypotension (β2) }}
|}
{{Family tree | | | | | |!| | | |!| | | |!| | | |!| | | |!| | |}}
{{Family tree | G01 | | G02 | | G03 | | G04 | | G05 | | G06 | |G01= '''Cautions''' |G02= Arrhythmia |G03= *'''Not in cardiogenic shock''' <br>*Arrhythmia <br> *Ischemia induced cardiotoxicity|G04= *Ischemic heart <br> *Gut ischemia |G05= *Bradycardia <br> *Heart block |G06= *Hypotension (add α1 agonist) }}
{{Family tree/end}}


==Do's==
==Do's==

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.

References

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