Day 3 - Pressors

What are “pressors”?

• Catch-all phrase to describe vasoactive medications that are used for circulatory or hemodynamic support - includes vasopressors and inotropes

• Vasopressors cause both arteriolar vasoconstriction and venoconstriction, thereby increasing the Mean Arterial Pressure, or MAP

• Inotropes increase cardiac contractility

Why do we use pressors?

• Goal is to maintain end organ or tissue perfusion – clinical endpoints like urine output, mentation, lactate clearance

• Generally target MAP of 60-65mmHg or SBP 90-100mmHg

When do we use them?

• Hypotension refractory to fluids – if the patient has received several litres with no response or is becoming volume overloaded, consider switching to vasoactive agents

• Always ensure adequate intravascular volume before initiating to prevent “squeeze” on empty vessels

What are the receptors each agent can act on?

What are the common pressors?

How do I decide which to use?