Vasopressor use is an everyday exercise in critical care. Unfortunately, high-level evidence regarding these agents is often lacking. Furthermore, patients may react in unique ways. This chapter attempts to clarify some vasopressor basics, but beware – all of your patients will not read the book.
-
The IBCC chapter is located here.
- The podcast & comments are below.
Follow us on iTunes
The Podcast Episode
Want to Download the Episode?
Right Click Here and Choose Save-As
Josh is the creator of PulmCrit.org. He is an associate professor of Pulmonary and Critical Care Medicine at the University of Vermont.
Latest posts by Josh Farkas (see all)
- IBCC chapter – Disseminated Intravascular Coagulation (DIC) - January 18, 2021
- PulmCrit- RCTs don't justify using convalescent plasma or antibody cocktails - January 14, 2021
- PulmCrit – Six RCTs to answer one question: what is the role of tocilizumab in COVID-19? - January 12, 2021
Milirinone is listed in the chapter as a adenylyl cyclase inhibtor. This would decrease cAMP. I think it is a phosphodiesterase inhibitor, which would decreases cAMP breakdown.
is isoproterenol the same as isoprenaline? if so you’ll be happy to hear its used regularly in Australia, i don”t know how much it costs but there is usually plenty of it available
Any new thoughts on angiotensin II since your last post on it? When I use heroic doses of norepi, epi, and phenyl plus vaso, I wonder if it would benefit Would good equipoise gives it a niche in some scenarios? I haven’t had access yet since it’s either not on formulary or very restricted by pharmacy.
Do you use metaraminol? Often seems to be peripheral agent of choice in major trauma in London.
Vasopressin is apparently sometimes administered subcutaneously for diabetes insipidus, so I’d assume that it can’t be that dangerous to administer peripherally? If you can just jam 10 units SQ (or IM), I don’t see how extravasation can cause any significant harm.
https://www.ncbi.nlm.nih.gov/pubmed?term=28377801 (see fig 2)
https://www.drugs.com/pro/vasopressin.html#s-34068-7
I’d check your dosing for the epinephrine infusion in the text. I think you mean 5-10 mcg/min, not 5-10 mcg/kg/min.
It’s very well organized topic