Titrating Multiple Pressors

  1. 1 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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  3. Visit  NSJodi} profile page

    About NSJodi

    NSJodi has '13' year(s) of experience and specializes in 'Transplant, IMC, BMT, CVICU, MICU,SICU'. From 'Minnesaota'; Joined Apr '10; Posts: 33; Likes: 27.

    15 Comments so far...

  4. Visit  MunoRN} profile page
    9
    These charts can be helpful;



    Sugarcoma, KbmRN, Spoiled1, and 6 others like this.
  5. Visit  eCCU} profile page
    0
    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. Visit  Esme12} profile page
    0
    LOVE the chart....but I need to know what the patients underlying pathology is that caused them to be in uncompensated shock.
  7. Visit  turnforthenurseRN} profile page
    0
    those charts are great, thanks for posting, Muno!
  8. Visit  Good Morning, Gil} profile page
    0
    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. Visit  NSJodi} profile page
    0
    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. Visit  Mully} profile page
    0
    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. Visit  emtb2rn} profile page
    3
    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. Visit  Spoiled1} profile page
    0
    Do you mind emailing me a copy of this chart?
  13. Visit  Spoiled1} profile page
    1
    disregard my last message, I see the link posted. Thanks.
    Esme12 likes this.
  14. Visit  detroitdano} profile page
    0
    I would wean off some and focus on a few. That's just too many vasopressors. Sounds like someone didn't know what to do and threw everything at the patient. If you've already got Levo and Neo, you don't really need Epi. And Vaso is sometimes best left at a sepsis dose while titrating two pressors.

    Why anyone would want the craziness of titrating three or more pressors is beyond me. If your patient needs that many pressors, usually it means they're severely acidotic, and if you're not already running a bicarb drip at that point, you need to be while finding out what the source of the acidosis is. If you can't correct the acidosis no amount of pressors are going to save them.
  15. Visit  Nrsasrus} profile page
    0
    Thank you, Muno!


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