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!
MunoRN, RN 8,058 Posts Specializes in Critical Care. Has 10 years experience. Dec 2, 2012 These charts can be helpful;
eCCU 215 Posts Specializes in CCU, CVICU, Cath Lab, MICU, Endoscopy.. Has 14 years experience. Dec 3, 2012 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....
Esme12, ASN, BSN, RN 4 Articles; 20,908 Posts Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 43 years experience. Dec 3, 2012 LOVE the chart....but I need to know what the patients underlying pathology is that caused them to be in uncompensated shock.
turnforthenurse, MSN, NP 3,364 Posts Specializes in ER, progressive care. Has 7 years experience. Dec 3, 2012 those charts are great, thanks for posting, Muno! :)
Good Morning, Gil 607 Posts Specializes in Rehab, critical care. Has 3 years experience. Dec 4, 2012 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.
NSJodi 35 Posts Specializes in ICU Rapid Response. Has 15 years experience. Dec 7, 2012 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!!
Mully 5 Articles; 272 Posts Specializes in SICU. Dec 8, 2012 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...
emtb2rn, BSN, RN, EMT-B 2,939 Posts Specializes in Emergency. Has 21 years experience. Dec 8, 2012 Found the link to the chart at http://sumed.stb.sun.ac.za:8001/rid=1H2H1NQ7P-1K6N9HS-60C/Vasopressors%20and%20Inotropes.cmapThe table lools like it's from a text. Great resouces.
Spoiled1, MSN, RN 463 Posts Specializes in Step-down ICU. Dec 11, 2012 Do you mind emailing me a copy of this chart?
Spoiled1, MSN, RN 463 Posts Specializes in Step-down ICU. Dec 11, 2012 disregard my last message, I see the link posted. Thanks.
detroitdano 416 Posts Dec 13, 2012 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.
