Pressors inotropes-sepsis and shock

• MAP target 65 mmHg as good as 80–85 and ↓ AF (NEJM 2014;370:1583; JAMA 2020;323:938)

• Norepinephrine: ↓ arrhythmia & mortality c/w dopamine (NEJM 2010;362:779; Crit Care Med 2012;40:725) and ∴ is pressor of choice in septic shock

• Vasopressin: adding to norepi (vs. using high-dose norepi) ↓ risk of AF & RRT by ~¼ (JAMA 2018;319:1889)

• If refractory vasoplegia: angiotensin II (Giaprezza), methylene blue, steroids (vide infra)

• If targets (see below) not reached after adequate fluids and pressors, consider inotropes

  • Targets-sepsis and shock