IV neosynephrine, vasopressine and dobutamine??? I am confused

[JuliaChambers]

Pt in cardiogenic shock + severe septic shock. Started originally on Levophed. Than transitioned to neo and vasopressin. Orders to wean off neo and than vaso. Pt did not tolerate weaning and bp dropped. Placed back on neo. Than dobutamine added to improve CO and orders to still try to wean off neo and than turn off vasopressin. I do not understand under thinking with dobutamine iv drip. was the drip started to be able to get read off other drips?. I am a new nurse and it is the first time I am exposed to that situation.

thank you

[icuRNmaggie, BSN, RN]

Was this patient acidotic

[Wile E Coyote, ASN, RN]

The Dobutamine was intended to address the cardiogenic shock. It's a potent sympathomimetic that increases cardiac output. The Levo and Neo were likely meant to primarily treat the septic shock. The ideal management strategy targets the underlying problem(s) as precisely as practical, so we like to pick the vasoactive meds who's desirable "personality" most closely addresses the specific problem. In a very simplified approach: Septic shock = inappropriate vasodilation, so we reach for a med that's primarily a vasoconstrictor (Levo). Cardiogenic shock = poor cardiac output, so we like primary inotropes like Dobutamine. The folks managing this pt had to walk a line and determine which problem was making this pt the sickest, and how their interventions affected the other problem(s).

[JuliaChambers]

yes. in metabolic acidosis. lactic above 2.

[JuliaChambers]

Thank you.