[fedewa0627]

I was wondering what the levophed (typical) max dose is used at your facilites.(20,30,40 mcg/min) Also at what point do your physicians say it is pointless to go higher just to get better b/p numbers.(ex. vasoconstiction to organs and b/p adequate but flow to organs becomes minimal.)

Thanks

[RNontheroad]

In my experience, it varies from unit to unit and thier policy. I have seen places where 20mcg/min is max and others where 30mcg/min is max. However in my experience, once you hit 20mcg/min, its time to try adding something to the mix.

[pinksugar]

50 mcg/min max at our hospital, but I have never used that much.

[CVICURN2003]

50 mcg/min, I have used it at that (and more) and Vaso (10) and epi (200+ c boluses) and sometimes neo all together. And one usually it is a 2:1 patient. Because the glucose is 500+ and you are running insulin at an insane amt...then they go on CRRT.....An unstable post CABG is a wonderful thing for us adrenaline junkies....

But one of our MD's says over 20mcg/min is useless. I have seen it work at higher rates.

[cardiacRN2006]

Originally Posted by RNontheroad

In my experience, it varies from unit to unit and thier policy. I have seen places where 20mcg/min is max and others where 30mcg/min is max. However in my experience, once you hit 20mcg/min, its time to try adding something to the mix.

In general we stop at 20mcg and consider a new drug. If desperate, then we've gone up to 30mcg. But I've never seen it higher than that, and it never seems to help over 20mcg anyway.

If I feel that 30mcg isn't helping, then it's time for some neo, epi, or vasopressin, and lastly dopamine. I've had pts on all of these-all maxed out, with bolus after bolus...

[meandragonbrett]

We stop our Levo at 100mcg, Dopa at 20mcg, Dobutamine at 20mcg, and epi we just tend to fly by the seat of our pants.

[TheNuttyNurse]

Your hospital policy may list a max. However, pharmacologically, there is no max. I have ran it wide open on a pressure bag along with a slew of other drugs running in addition. But, at that point, none of it's going to matter anyway. Also, pressors are not very effective in acidotic folks with ph less than 7.2, so treating the underlying cause and bicarb support can be very important in those really sick folks.

[VandyNurse714]

Originally Posted by CVICURN2003

50 mcg/min, I have used it at that (and more) and Vaso (10) and epi (200+ c boluses) and sometimes neo all together. And one usually it is a 2:1 patient. Because the glucose is 500+ and you are running insulin at an insane amt...then they go on CRRT.....An unstable post CABG is a wonderful thing for us adrenaline junkies....

But one of our MD's says over 20mcg/min is useless. I have seen it work at higher rates.

That sounds like so much fun...I work in the MICU now, but I would someday LOVE to work in the CVICU...can't wait!!

[CVICURN2003]

It's horrible to thrive on someone else's sickness.....but I like it when we make them better (which happens quite often believe it ornot). One of our surgeons and I had a discussion the other day becasue it is a well known fact that the "sicker they are, the more I like 'em". If someone works in our environment and does not LOVE that rush...they are so lying. You can't do what we do and not thrive on the words...."We need the "OH MY GOD cart" aka open chest cart. Ofcourse, some days a nice stable heart that extubates in less than an hour and is up to the chair in two hours is just as rewarding. Every Day is different. But, I love it most days......

[VandyNurse714]

Yeah, it is horrible to thrive on others' sickness, but I am an adrenaline junkie as they say. Of course I don't enjoy others being sick, but I love my job...unfortunately my having a job requires someone else to be quite ill...but then I get to try to make them better! I suppose it's all in how you look at it...