[Putu2Sleep]

We would go to our sepsis protocol which is 300mcg/min max and Neo we would go to 700mcg. This is only for our really septic shock patients

[gradcare]

Generally we need to remember that noradrenaline (or any other trope) is a poor substitute for adequate fluid reses. That said, in the setting of an adequately fluid loaded patient if you've hit 20 mcg/min with no result then you need to add another agent and look at their SVRI to determine what is the cause of the refractory hypotension (pump failure vs actual vascular depletion vs relative vascular depletion [vasoldiation]) If no result with 30 then perhaps some hydrocort plus a second agent, then a third etc.

Been in the goo acouple of times where the clinical picture is muddied to see what we needed to do cia PICCO / SCVO2 /Swann / or some other cardiac measure.

Guess my point is if your current thing ain't working it's time to see if what you were dealing with is what's happening and to add something else.

Cheers.

[foxyhill21]

I was wondering why some of the nurses where whispering "levophed leave em dead"... I had a pt on levophed and I stopped after 30mcg and told the doc that i had max out on levoped, so he added a vasopressin 0.02 then the dude max out on vaspressin.

Originally Posted by Jumpsuit Jim

Back in the day, before Levophed was first line for sepsis, we called it "leave 'em dead" or "dead in the bed" and was a last resort drug. Just be smart about it.

[meandragonbrett]

Our facility policy says 100mcg/min of norepi. We routinely use higher dosages. Just depends on what the patient needs and what's going on.

[nursejill155]

As with anything in nursing each doc and facility is different. At our facility we say our "max" dose is 1 mcg/kg/min or 12mcg/min. Which from what others are saying is low, I have ran it higher before but you must think once you get to a certain dose and its not working it is time to think to start something else whether it be neo or vaso. You have to look at the patient to decide but thats usually my rule of thumb, start something else if you are maxed and it is not working. I hope that helps.

[drew9319]

Most of the drug books state .18mg/min or 180mcg/min is the max dose for sever hypo or sepsis. Go by your hospital guidlines. That will be your best bet, and it also gives you cover if anything comes from the death of a pt. It is always best to follow the hospital protocol. Hope that this helps.

Navy Nurse Corp

[nrs_grl]

Our ICU pharmacist ( who is absolutely wonderful and know everything ) has had this discussion quite a bit with us. There is really no "max" dose of levophed, but if a person is septic they will more likely respond to vasopression.

[jspacegirl]

Wow, I saw a patient today on 200 mcg/min of levo! I had no idea just how high that was until I started reading this post :-)

[lorilou22RN]

Originally Posted by nursejill155

As with anything in nursing each doc and facility is different. At our facility we say our "max" dose is 1 mcg/kg/min or 12mcg/min. Which from what others are saying is low, I have ran it higher before but you must think once you get to a certain dose and its not working it is time to think to start something else whether it be neo or vaso. You have to look at the patient to decide but thats usually my rule of thumb, start something else if you are maxed and it is not working. I hope that helps.

I too agree that that is a VERY low dose of levo. I think that tho some of the posts are really keying in on the severe sepsis pt. We have run levo obviously wide-open with severe hypotension, while initiating vaso at max dose. This of course is not for long term..just get the patient stabilized. Most patients tho, that have such high doses administered are not going to survive, it doesn't matter what else is initiated. Our usual concentration is 8mg/250cc, but for those that are receiving high doses we will mix 16mg/250. It just depends. We really have no policy that states how high you can go with Levo. It states: "Titrate for pt response/physician parameters."

[lorilou22RN]

Originally Posted by foxyhill21

I was wondering why some of the nurses where whispering "levophed leave em dead"... I had a pt on levophed and I stopped after 30mcg and told the doc that i had max out on levoped, so he added a vasopressin 0.02 then the dude max out on vaspressin.

they used to say that because of the side effects associated with high dose Levo. ie: Kidney failure (of course hypotension will cause that too!), necrotic fingers/toes etc. It will completely clamp down the peripheral vasculature in order to raise BP, you can definately sacrifice other body systems with this, or risk amputation of limbs....it all depends on how far the patient/family wants to go in order to "survive"