fedewa0627

We are working on bringing it to our facility as well. Sorry, no order set yet but I also would like to see some info. I just had a pt clot off 4 cvvh filters last night.

In my experience our physician prefer to wean the vasopressin before levophed. Often it is up to the physician because vasopressing is still in it's infancy of being understood. At my facility vasopressin is either on or off, no titration. Levophed is ofter titrated and is much easier to see a direct cause and effect relationship on b/p with dose changes.

I was wondering what the levophed (typical) max dose is used at your facilites.(20,30,40 mcg/min) Also at what point do your physicians say it is pointless to go higher just to get better b/p numbers.(ex. vasoconstiction to organs and b/p adequate but flow to organs becomes minimal.) Thanks

I had a patient the other day that was on 2 mcg/min of levophed with b/p of 110/50. His blood pressure 2 hours into the shift drops into the 60/40. I increased my levophed to 10 mcg/min and his blood pressure responded to 115/50. When I alerted the resisdent to this rapid increase in levophed he asked for a CVP. I measured a cvp of 12 (pt on vent with peep of 5) After informing him of the CVP, he states that b/c the CVP is adequate no fluid bolus is needed for the blood pressure drop(lasix drip on pt and urine output 50ml/hr). My question is if increasing my levophed causes an increase in CVP because of the increase peripheral vascular resistance(increasing central venous blood return). This would make the cvp measurement after the increase in levophed an inacurate measure of fluid volume staus. Can someone help me with a sound physiologic type answer? thanks

Thanks, if possible could you post a site where I can find that information.

Why is normal saline the only solution used for blood transfusions? How come lactated ringers or Normosol-R cannot be use with packed red cells. This is the practice at my hospital, let me know if you have seen different and why. Thanks.