Re: How high have you titrated levophed? Originally Posted by chani 
highest inotrope rate for was in a 16yr old with meningococcal sepsis (before Xygris) was quad strength noradrenaline [aussie for levophed] (24mg in 100mls) at 80mls per hour PLUS the same in adrenaline. She also had fulll invasive monitoring AND plasmaexchange AND haemofilitration. These rates went on for 2 days before bilateral below knee amputations. When desperate you do desperate things.
Did she live? Indeed she did. The cost was her kidneys her legs and arms below elbows. Now this was 12 years ago.
However racingmum it doesn't sound like your patient was getting optimal therapy as pointed out by other posters. If the above patient happened again it would be xygris and/or IABP much sooner OR amputation of severely effected limbs sooner OR BOTH. For the record dopamine or dobutamine are not used in adult intensive care units for shock. Adrenaline or levophed are the inotropes/vasopressors of choice.
Not wishing to generalise too much but I think WE are luckier than most of our north american cousins in that we generally have closed ICUs run by trained intensivists who develop close relationships with the nursing staff AND one-to-one nursing for ventilated patients. SO getting your point across can be easier.
Same here, we have a closed unit and one-to-one nursing which generally makes for a better working relationship.
The most I have used was quad strength noradrenaline (320mcgs/ml) at 50mls per hour, plus adrenaline, pt arrested on arrival, got him back, started on filter, bp crashed again, pt navy blue despite vent...crashed and died. The awful thing was the family were willing to let him go and the doctor just kept on banging out the orders, effectively he deprived the family of the chance of spending some time with the patient.
Sometimes it isn't 'can we' but rather 'should we'.
) but my wife says she's gone up to 64 mcg's.
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