Vasopressin for Septic Shock

ccrnjen · May 1, 2006

Want to bring this thread back to see what everyone has been doing in the last year or two. I have seen wonderful results with Vasopressin in septic shock - 0.04 units/min max dose. Many of the people at the facility I currently work at think that vasopressin and levophed are the work of the devil. The surgeons particularly are stuck on the "dead gut" risk and have brainwashed everyone here. They all think I am nuts when I tell them that levo is first line and does not increase the risk significantly when used early and that vasopressin has very good results as well. I know the VASST study is underway - any idea when that is expected to be complete?

dorimar, BSN, RN · May 2, 2006

I believe the 0.04 units/ min is for varicies and the .01-.08 units /min is for septic shock. Due to the potential cardiac ischemia and increased MVO2, and mesenteric ischemia, the lower doses the better.

dorimar, BSN, RN · May 2, 2006

I wanted to add that on'e of the pre-requisites to start xigris, at least where I work, is hypotension unresolved by fluid resucitation (as well as evidence of 2 systems failing i think). Hence pateitns are ususally already on a pressor before xygris is started.

neneRN, BSN, RN · May 3, 2006

About a year ago, we started a nurse-initiated sepsis screening process (modified by one of our ICU docs from some sepsis study) in the ER so we can detect sepsis earlier and get them out of the ER and into the ICU faster. Any pt that meets a trigger (on mechanical ventilation/on vasopressors/on >40% O2) gets screened. They have to meet certain criteria evidenced by their VS/lab results AND have either a lactate of >4 or be vasopressor dependant to meet full sepsis criteria; when this happens, they are candidates for Early Goal Directed Therapy and the ICU gets them out of the ER within an hour. I don't know exact numbers, but apparently our sepsis related deaths are way down. (The ICU docs were even giving out gift certificates to the ER nurses who screened the most pts each month for a while!) Just curious if anyone else is doing this screening process?