Titrating Multiple Pressors

Specialties MICU

Published

Specializes in ICU Rapid Response.

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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Specializes in Critical Care.

These charts can be helpful;

SBReadResourceServlet?rid=1H2H1NQ7P-1K6N9HS-60C&partName=htmljpeg

Drugs By Adrenergenic Receptor Type Indications, Advantages, And Disadvantages Emergency Medicine Practice.JPG

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Specializes in CCU, CVICU, Cath Lab, MICU, Endoscopy..

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....

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

LOVE the chart....but I need to know what the patients underlying pathology is that caused them to be in uncompensated shock.

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Specializes in ER, progressive care.

those charts are great, thanks for posting, Muno! :)

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Specializes in Rehab, critical care.

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.

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Specializes in ICU Rapid Response.

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!!

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Specializes in SICU.

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...

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Specializes in Emergency.

Found the link to the chart at http://sumed.stb.sun.ac.za:8001/rid=1H2H1NQ7P-1K6N9HS-60C/Vasopressors%20and%20Inotropes.cmap

The table lools like it's from a text.

Great resouces.

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Specializes in Step-down ICU.

Do you mind emailing me a copy of this chart?

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Specializes in Step-down ICU.

disregard my last message, I see the link posted. Thanks.

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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.

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