LEVO or VASO--which to wean first?

[poppy07]

I had a pt last 2 days, septic shock, 1 wk s/p c-section, ARF, ARDS, HR 150's (previous day 160's to 170), on Vaso and Levo. Which would you have weaned first and why?

[yeSICU]

I personally always like to get rid of Levo ASAP... Something about the whole "Leave em dead" rhyme gets me all antsy. We run Vaso at a standard rate. We call it "Shock dose Vaso". I love vaso because you don't get the peripheral clamp down, aka your pt. keeps their toes and finger tips. Docs seem to think the same way, as far as rationale pharmacologically speaking, I will have to get back with you on that.