An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
It is my personal opinion that sepsis-induced cardiomyopathy has been under recognized and understudied. Our current practice pattern of starting patients on norepinephrine is good. But automatically going to vasopressin, then either phenylephrine or epinephrine as they continue to deteriorate overlooks the fact that they may have sepsis-induced cardiomyopathy. Going down the typical route we …
Continue reading Sepsis Induced Cardiomyopathy: A Forgotten Factor in Septic Shock
Which should be the first-line vasopressor between norepinephrine and epinephrine in cardiogenic shock?Your patient had an MI and is now in cardiogenic shock.They are hypotensive and need a vasopressor.To clarify, The Crit Doc of Tik Tok aka CriticalCareNow aka Haney Mallemat likes epinephrine as an inotrope, not a vasopressor.This was a pilot study, meaning that …
Continue reading Norepinephrine or Epinephrine in Cardiogenic Shock: Is One Better?
Is your institution a milrinone shop or a dobutamine shop? Or do you have a mixed shop?It seems that most institutions are accustomed to use mostly one or the other in cardiogenic shock.Some argue that milrinone is better.Some argue that dobutamine is better.But do we know the answer?This was answered late in 2021 in the …
Continue reading Milrinone or Dobutamine in Cardiogenic Shock?
The intention of this post is going to be to take a deep dive into the states of vasopressors using the best evidence based practices available. It will be routinely updated. This is a work-in-progress blog post on vasopressors. Last updated 02/25/2022.If you find this blog post useful, and you want to cite it in …
This is a question that is often asked. Do we give fluids until the patient no longer "responds to fluids" or start vasopressors early? Should we start early vasopressors in septic shock or wait until fluids resuscitation is complete?Here's my bias: I dislike arbitrarily pounding patients with fluids. It causes harm. We know this. I …
Does your friendly neighborhood cardiologist or intensivist start your Cardiogenic Shock patient on dopamine? Do you ever ask them when was the last time they read a study? I don’t mean to be harsh but this data is now almost a decade old. This study placed dopamine far down on the vasopressor selection totem pole. …
Continue reading Dopamine for Cardiogenic Shock: Shown to Increase Mortality.
