SCCM Resource Library-Rethinking Vasopressors: Evolving Evidence and Emerging Concepts in Vasopressor Administration

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The 2024 Critical Care Congress discussed evolving practices in vasopressor administration in ICU settings due to their significant patient care, safety, and cost implications. The session "Rethinking Vasopressors" highlighted three main topics.<br /><br />Firstly, Patrick Wieruszewski, PharmD, explored when to use vasopressors beyond norepinephrine and vasopressin. Current guidelines recommend a stepwise addition of vasopressors, but guidelines are vague, and clinician practices vary. Wieruszewski emphasized the need for a precision-based approach, moving beyond time-consuming, stepwise methods to biomarker-guided therapy, potentially incorporating catecholamine-sparing agents like angiotensin II to manage shock more effectively.<br /><br />Next, Ithan D. Peltan, MD, discussed the timing of vasopressor initiation in septic shock, referencing the CLOVERS trial, which showed no significant mortality difference between restrictive and liberal fluid strategies. Variation in practice extends to vasopressin use, with hospitals showing diverse initiation thresholds unrelated to patient-specific factors. Peltan's Vasopressin for Septic Shock Pragmatic Trial aims to establish clearer initiation thresholds for vasopressin.<br /><br />Elizabeth S. Munroe, MD, addressed whether central lines are necessary for vasopressor administration. Historically limited to central lines to prevent tissue injury from extravasation, newer guidelines support initial peripheral administration, recognizing its practical advantages, such as faster use and fewer complications. Munroe highlighted the crucial role of protocols in ensuring the safe use of peripheral vasopressors, stating that most critical care facilities must adapt their policies to leverage the benefits of peripheral administration safely.<br /><br />The session underscored the need for further research and innovation to refine vasopressor practices, optimize treatment, and improve patient outcomes in critical care settings.

Asset Subtitle

Cardiovascular, 2024, 0:09:00

Asset Caption

"This article was first published in the Summer 2024 issue of Critical Connections.

Vasopressors are among the most prescribed medications
in the intensive care unit. Unfortunately, the optimal approach to vasopressor administration remains unknown, causing wide variation in vasopressor administration across practices, which has broad implications for patient care, safety, and costs.

Critical Connections, the critical care industry’s only newsmagazine, provides information on cutting-edge topics in critical care useful to the entire multiprofessional team."

Meta Tag

Content Type Article

Knowledge Area Cardiovascular

Knowledge Area Pharmacology

Membership Level Associate

Membership Level Professional

Membership Level Select

Tag Vasoactive Agents

Year 2024

Keywords

Critical Care Congress

vasopressor administration

ICU settings

biomarker-guided therapy

catecholamine-sparing agents

septic shock

CLOVERS trial

vasopressin initiation

peripheral administration

patient outcomes

Article

Cardiovascular

Pharmacology

Vasoactive Agents

2024

Associate

Professional

Select

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