UMEM Educational Pearls

Vasopressors are used in shock-states to increase mean arterial pressure (MAP) and improve distal tissue perfusion. Additionally, some agents have effects on the heart to augment cardiac output.

Receptors that vasopressors work on include: 

  • Alpha-1: increase arterial tone (increases MAP) and venous tone to reduce venous pooling and augment cardiac preload 
  • Beta-1: increase inotropy and chronotropy on heart muscle; also increases arterial tone
  • Beta-2 and Dopamine: cause vasodilation but may actually be beneficial because this increases perfusion to cardiac, renal, and GI tissues.
  • V1: arterial vasoconstriction to increase MAP
  • The chart below is a summary; please note that quoted receptor effects vary depending on the source reviewed

Norepinephrine (NE): excellent vasopressor for most types of shock and recommended as a first-line agent in the Surviving Sepsis Guidelines.

  • Works on alpha-1, beta-1, and beta-2 receptors. 
  • Initial dosing 0.05 mcg/kg/min with a maximum dose often cited as 0.5 mcg/kg/min (though there is technically no maximum dose).

Epinephrine (a.k.a. Adrenaline): in several countries the first-line agent for shock (including sepsis).

  • Works similarly to NE on alpha-1, beta-1 and beta-2; it is a more potent inotrope than NE.
  • One downside is the production of lactic acid, which can sometimes lead to confusion when following serial lactates during resuscitation. 



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