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Septic shock is usually related to extreme vasodilation. Levo is a strong alpha adrenergic stimulator which will cause arterial/venous constriction. Dopamine has alpha effects at high doses, but also has some pretty potent beta effects as well. The increased HR and oxygen demand are effects that are not needed in septic shock, so levo is the drug of choice.
Another point to make is that Dopamine will usually need to be run at higher doses to be effective when dealing with sepsis..as dopamine at higher doses is equivalent to Norepi, why not start with the norepi which you know will work? You'll be wasting precious time titrating low dose Dopa which won't get the desired result.
Now, another point to bring up is the increasing use of Vasopressin for sepsis. There is information out there that Vaso is actually more effective than Norepi...but it's not the gold standard yet. What you'll run in to is the idea that physician preference may play a larger role in what is your first line vasopressor than actual evidence-based medicine. I'd encourage you to do a medline search for articles on the use of vasopressin and see what your docs impressions are. I know personally, I've had good outcomes with using vasopressin.
I tried reading the data on vasopressin use for sepsis, whatever it's dosed, IIRC it's 0.04 units/min, after I had a lady on it for the first time.
The data doesn't thoroughly support its use. Most studies say "Eh, it seems to work, go for it but be cautious." I even asked our fellow and he said the data isn't super strong either.
What meandragonbrett said...and see this:
I agree with all the above plus: The bacteria blocks the neurotransmitter sites in your cardiovascular system that control blood pressure; Levophed (norepi) infused is like throwing a handful of darts at a dartboard and hope at least one molecule of norepi will stick to a neurotransmitter site not in use by the bacteria. Which will hopefully improve BP.
Wow thanks guys! I have been in ICU for 9 mos now, and i always knew that Dopamine wasnt used as much because of the higher HR, but i never realized it had anything to do with O2..not sure if i just missed this information while working with these patients, or if it wasnt presented to me at all..but i know now! eh..i learned something after all :)
diosadelsol, ADN, BSN, MSN, RN, APRN, CRNA
52 Posts
I was just wondering if anyone out there can tell me why Levophed is the pressor-of-choice over Dopamine for Septic Shock pts?
Thanks