[pietr422]

I am a nursing student with 5 weeks to go until graduation. I just finished my senior practicum in the ICU, during which I had a septic patient with severe septic shock. This patient was on levo and vaso, and my preceptor and I were trying to wean the vaso first per the MD order. As we decreased the vaso which was originally running at 0.04 units/hr, we found that the patient's pressures would not tolerate the decrease, so we titrated the levo up to compensate, which was minimally effective. After fussing around for quite some time, we put the patient back on the 0.04 units/hr of vaso and returned the levo to its original rate.

Anyway... I found an interesting article titled about the topic of pressors and septic shock. I would definately recommend it as it is worth the read and explains how each of these pressors works to manage hypovolemia secondary to septic shock.

Anyway, based on this article, I would wean the vasopressin first.



http://ccn.aacnjournals.org/cgi/content/full/26/6/17





-Andy

[VandyNurse714]

We don't titrate vaso in our unit, either. It is also running at 0.04 units/hr. I would ask the doctor at what point would he or she prefer turning the vaso off. I feel more comfortable with levo, so I would rather get the vaso weaned completely off (while simultaneously weaning levo bit by bit) then coming down solely on the levo. I would venture to say that patient would tolerate weaning something at this point with MAP in the 70s and 80s, CVP 12-15, and HR in 150s. That HR concerns me as well.

[yeSICU]

I personally always like to get rid of Levo ASAP... Something about the whole "Leave em dead" rhyme gets me all antsy. We run Vaso at a standard rate. We call it "Shock dose Vaso". I love vaso because you don't get the peripheral clamp down, aka your pt. keeps their toes and finger tips. Docs seem to think the same way, as far as rationale pharmacologically speaking, I will have to get back with you on that.