What is the role of vasopressor therapy in the treatment of multiple organ dysfunction syndrome (MODS) in sepsis?

Updated: Jan 27, 2020
  • Author: Ali H Al-Khafaji, MD, MPH; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

When proper fluid resuscitation fails to restore hemodynamic stability and tissue perfusion, initiate therapy with vasopressor agents. The agents used are norepinephrine, epinephrine, vasopressin, dopamine, and phenylephrine. These drugs maintain adequate blood pressure during life-threatening hypotension and preserve perfusion pressure for optimizing flow in various organs. Maintain the mean BP required for adequate splanchnic and renal perfusion (mean arterial pressure [MAP] of 65 mm Hg) on the basis of clinical indices for organ perfusion.

Norepinephrine is the first-choice vasopressor. Epinephrine (added to and potentially substituted for norepinephrine) can be used when an additional agent is needed to maintain adequate blood pressure. Vasopressin at 0.03 units/minute can be added to norepinephrine with the intent of either raising MAP or decreasing norepinephrine dosage. Dopamine as an alternative vasopressor agent to norepinephrine is used only in highly selected patients (eg, patients with low risk of tachyarrhythmias and absolute or relative bradycardia). Phenylephrine is not recommended in the treatment of septic shock, except in circumstances when norepinephrine is associated with serious arrhythmias, cardiac output is known to be high and blood pressure is persistently low, or as salvage therapy when combined inotrope/vasopressor drugs and low-dose vasopressin have failed to achieve MAP target. [20]


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