Vasopressors
Revision as of 14:41, 20 December 2014 by Rossdonaldson1 (talk | contribs)
Background
The goal of vasopressor use is to reach critical organ perfusion pressure. Estimated required mean arterial pressures (MAP) are listed below. It is generally safe to aim for a goal map of 65 mmHg. Vasopressors also promote increased venous return.
IV Vasopressor have not been shown to be unsafe when used peripherally[4] If running peripherally perform frequent site check via institutional protocol. [5]
Types
Push Dose Pressors
- Use when need temporary BP or CO boost
- Post-intubation hypotension
- Propofol-induced hypotension
- A-fib w/ hypotension
- Easier to convert well-perfused heart
Epinephrine
- Mix 9mL of NS with 1mL of 1:10,000 epi
- Now have 10mL of 10mcg/mL
- Use 0.5-2mL q2-5min (similar to epi drip)
- Same as 2% lido with epi
- Ok to give peripherally
- Now have 10mL of 10mcg/mL
- Onset - 1min
- Duration - 5-10min
Phenylephrine
- Pure alpha (no effect on heart)
- Place 1mL of 10mg/mL vial in 100mL NS
- Now have 100mcg/mL
- Draw up 10mL
- Use 0.5-2mL q2-5min (50-200mcg)
- Onset - 1min
- Duration - 20min
Source
- ↑ Plöchl, W, D J Cook, T A Orszulak, and R C Daly. 1998. Critical cerebral perfusion pressure during tepid heart operations in dogs. The Annals of thoracic surgery, no. 1. http://www.ncbi.nlm.nih.gov/pubmed/9692450
- ↑ Emcrit Vasopressor basics http://emcrit.org/podcasts/vasopressor-basics/
- ↑ Bellomo, Rinaldo, Li Wan, and Clive May. 2008. Vasoactive drugs and acute kidney injury. Critical care medicine, no. 4 Suppl. doi:10.1097/CCM.0b013e318169167f. http://www.ncbi.nlm.nih.gov/pubmed/18382191.
- ↑ Ricard JD. et al. Central or peripheral catheters for initial venous access of ICU patients: a randomized controlled trial. Crit Care Med. 2013 Sep;41(9):2108-15
- ↑ Chen J. et al. Extravasation injury associated with low-dose dopamine.. Ann Pharmacother. 1998 May;32(5):545-8
- EmCrit Podcast 6