Titrating Multiple Pressors

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  1. This is a discussion on Titrating Multiple Pressors in MICU / SICU Nursing, part of Critical Care Nursing ... Tonight I had a patient on Norpinephrine, Epinephrine, Phenylephrine, Dopamine and Vasopressin with...

    by Dec 2, '12
    Tonight I had a patient on Norpinephrine, Epinephrine, Phenylephrine, Dopamine and Vasopressin with orders to titrate all of them to MAP> 60. My question is, does anyone have any advice when titrating this many pressors? I'm good with titrating two or three, but totally lost when dealing with this number. Granted in this patient's case she was maxed so titration really wasn't an issue, but in the future any advice? Thanks!
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    by NSJodi Dec 2, '12 10:41 am
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  3. 15 Comments so far...

  4. Dec 2, '12 by
    These charts can be helpful;



    Sugarcoma, KbmRN, Spoiled1, and 6 others like this.
  5. Dec 2, '12 by
    What was the case...details...did they have a PA catheter? IABP and what were the numbers? Technically when you have that many pressors one had to have numbers to titrate. Was it a cardiogenic shock, septic or what was going on. Give us the picture and we can guide you on the titration process....
  6. Asst. Admin
    Dec 3, '12 by
    LOVE the chart....but I need to know what the patients underlying pathology is that caused them to be in uncompensated shock.
  7. Dec 3, '12 by
    those charts are great, thanks for posting, Muno!
  8. Dec 4, '12 by
    I've only been an RN in ICU for a little over a year, but when there are that many pressors, I have yet to encounter a situation in which I can wean them. Most of the time they are maxed or near max anyway and the patient is near death. If I'm titrating at all, I'm just increasing them at that point. For instance, if HR is tachy in the 130's, and pressure is your only issue, starting to drop, then my first go to: neo drip, purely alpha and will only act on the BP, not effecting/increasing HR at all, so I'd titrate that one up to max. If you know which receptors the pressors act on, then you'll have a better understanding of which to titrate first.
  9. Dec 6, '12 by
    Thanks everyone who responded and thanks for the tables! I should have given more information, but I was more interested in how to titrate for the future. No, this patient didn't have a swan line so I was lacking in information. Thanks again for the help!!
  10. Dec 8, '12 by
    Can you post these in as a PDF or Word file? Or give a link to them on the internet? I'd love to print and study them...
  11. Dec 8, '12 by
    Found the link to the chart at http://sumed.stb.sun.ac.za:8001/rid=...Inotropes.cmap

    The table lools like it's from a text.

    Great resouces.
    Spoiled1, turnforthenurseRN, and Mully like this.
  12. Dec 10, '12 by
    Do you mind emailing me a copy of this chart?