vasopressors

• Venous vasoconstriction = most important. Less important to increase SVR -NE: less splachnic/myocardial ischemia than epi. less digit ischemia than vasopressin. Diminishing returns after 1-2 mcg/kg/min

##When to start Some evidence (earlier normalization of perfusion indices) for earlier than hypotension despite 30cc/kg bolus cyrstalloid: CENSER trial DOI: 10.1164/rccm.201806-1034OC

##shock targets -baseline hypertension: 80 -100-140 baseline sbp: 65

• baseline less than 100: 60

citation doi: 10.1164/rccm.202004-1124ED

Elderly: 60 (citation and criteria)

Interestingly - risk of digit necrosis might be an old wives tail - review here: https://www.aliem.com/myth-vasopressors-ischemia/ and that purpura fulminans (sepsis associated activated protein c dysfunction causing microthrombi) with digit ischemia.