Vasopressors & Inotropes in Sepsis 

 

  • Initial MAP target = 65 mmHg.  Use an arterial line when possible

  • Norepinephrine = 1st line vasopressor 

  • Vasopressin (up to 0.03 units/min) or Epinephrine can be added if a second vasopressor is needed 

  • Dopamine can be used as an alternative vasopressor agent to norepinephrine in very select patients (e.g., bradycardic patient who is at low risk of tachyarrhythmias).  Dopamine is not useful for renal protection 

  • A trial of dobutamine infusion up to 20mcg/kg/min can be added to vasopressors in presence of low cardiac output or hypoperfusion despite adequate intravascular volume/MAP

  • Phenylephrine should be avoided (insufficient evidence, potential for splanchnic vasoconstriction) 

 

 

Adapted from Surviving Sepsis Guidelines 2016. Critical Care Medicine: March 2017 - Volume 45, Issue 3, p 486–552