Vasopressor resident survival guide

Sepsis Microchapters
Home
Patient Information (Adult)
Patient Information (Neonatal)
Overview
Pathophysiology
Causes
Differentiating Sepsis from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Vasopressor resident survival guide On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Vasopressor resident survival guide All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Vasopressor resident survival guide
CDC on Vasopressor resident survival guide
Vasopressor resident survival guide in the news
Blogs on Vasopressor resident survival guide
Directions to Hospitals Treating Sepsis
Risk calculators and risk factors for Vasopressor resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Zaghw, M.D. [2]

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.