SCCM Resource Library-Under Pressure: Use of Vasoactive Therapies Beyond the Guidelines

Video Transcription

Video Summary

In this session, the speakers discuss the titration and discontinuation of vasopressors in the treatment of shock. They start by discussing the various vasoactive agents that are currently available and their different receptor activities. They then highlight the lack of guidelines and variability in practice when it comes to titrating these agents. One approach that has been taken is the addition of titration instructions to medication orders to assist nurses in their administration. However, the effectiveness of this approach is still unclear. The speakers also discuss the discontinuation approach for patients receiving both norepinephrine and vasopressin. They note that there is some evidence suggesting that discontinuing vasopressin first may be associated with an increased risk of hypotension, but it does not impact short-term mortality. They also mention the high cost of vasopressin and the potential for cost savings by discontinuing it earlier. Finally, they discuss the emerging use of angiotensin II as a vasopressor, particularly for patients with angiotensin II deficiency or resistance. They highlight the potential use of renin as a biomarker for identifying these patients. Overall, the speakers emphasize the need for more research and guidelines to improve the titration and discontinuation of vasopressors in the treatment of shock.

Asset Subtitle

Pharmacology, Shock Non Sepsis, 2020

Asset Caption

The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2020 Critical Care Congress held February 16-19, 2020, in Orlando, Florida, USA.

Learning Objectives

Review the current evidence surrounding effective titration and discontinuation of vasopressors
Recognize the utility of evidence-based and protocolized vasopressor use in the intensive care unit
Discuss novel vasopressor agents in catecholamine-resistant hypotension

In the Details: Titrating and Discontinuing Vasopressors

Gretchen L. Sacha

Protocolized Vasopressor Utilization: Regulatory Considerations

John J. Whitcomb

Emerging Evidence: Where Do New Vasoactive Treatments Fit?

Laurence W. Busse

Meta Tag

Content Type Presentation

Knowledge Area Pharmacology

Knowledge Area Shock Non Sepsis

Knowledge Level Advanced

Membership Level Select

Membership Level Professional

Membership Level Associate

Tag Vasoactive Agents

Tag Guidelines

Tag Shock

Year 2020

Keywords

titration

discontinuation

vasopressors

shock

vasoactive agents

guidelines

variability

norepinephrine

angiotensin II

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