The Basics of Vasopressors
There is a ton to speak about regarding vasopressors, but before we get to the edge cases, we need to set-up a foundation.
Types of Shock
It's all about flow!
- Should we get rid of blood pressure?
Critical Perfusion Pressures
- MAP of 50 in non-vasculopath dogs for the brain? (9692450)
- MAP of 65 for the heart? (Dunser et al. think it is 45-50 for the heart)
- MAP 65-75 for the Kidneys? (18382191)
When we put someone on a vasopressor, what are we hoping to accomplish?
- Critical Perfusion Pressures (Heart will get better, but may look worse)
- Increase Venous Return
- Avoid Gut Ischemia and Flow Reduction
Norepi Increases Venous Return as well as Constricting Afterload
- Crit Care Med. 2012;40(12):3146-3153
- Crit Care Med. 2011 Apr;39(4):689-94
- Crit Care Med. 2013 Jan;41(1):143-50
- Critical Care 2007, 11(Suppl 2):P37
- Critical Care 2010, 14:R142
- Anesthesiology 2014; 120:365–77
- Want to understand the physiology of venous return?
MAP of 65 or Higher?
No benefit to 80-85 group (24635770)
Vasopressor Flow Chart
Update: The Hinds Perspective
- ‘pressors/catecholamines/inotropes are not so helpful
- Pure Pressors
- Inodilators (another show)
Should become weight based
Should tolerate tiny doses
Why Not Dopamine?
'cause it is crappy
Effects on Mortality
Up and Coming Vasopressors to be Discussed in Future Episodes
Very Good Review Article on the Effects of Vasoactive Agents on Microcirculation
Great Review (20811874)
Review Articles(12386503) (21097695)
Understanding Venous Return(24966066)
Must Read Posts By Josh Farkas
- Early MAP Stabilization
- Renoresuscitation 12/2014
- Vasopressin & renal function 12/2014
- VANISH trial & vepinephrine 8/2016