J Clin Outcomes Manage
Use of vasopressors in septic shock
Rech MA, Prasse M, Patel G
Abstract: Objective: To review the latest findings on the use of vasopressor agents in septic shock. Methods: Review of the literature. Results: The Surviving Sepsis Campaign guidelines recommend norepinephrine or dopamine as first-line vasopressor therapy for patients with septic shock. However, recent publications have demonstrated that dopamine has a less desirable side-effect profile than norepinephrine, especially in patients at increased risk of cardiovascular events. Therefore, dopamine should no longer be considered a first-line vasopressor, especially in patients with a history of cardiovascular disease. Currently, the role of vasopressin is adjunctive therapy to other vasopressors like norepinephrine and dopamine. Epinephrine and phenylephrine should be reserved for those patients requiring multiple vasopressors, unless patient-specific parameters preclude the use of first-line agents. When patients require multiple vasopressors to maintain mean arterial pressure goals, selection of a second vasopressor agent should be based on individual hemodynamic parameters and patient-specific comorbidities. Conclusion: As new research is conducted, the role of each vasopressor in septic shock will be more clearly defined.
Clinical Review Article
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