💉 Vasoactive Agents & MAP Target in Septic Shock
Vasoactive-agent and MAP-target framework for septic shock, following the Surviving Sepsis Campaign escalation sequence.
Vasoactive Agents & MAP Target in Septic Shock
Current MAP (after adequate fluid resuscitation) (mmHg)
Current vasoactive agent
Cardiac dysfunction with persistent hypoperfusion
When to use
Use after adequate fluid resuscitation to set the MAP target and choose the next vasopressor/inotrope/steroid step.
How it works
Initial MAP target ≥ 65 mmHg; norepinephrine first-line → add vasopressin 0.03 U/min → add epinephrine; add dobutamine (or switch to epinephrine) for cardiac dysfunction with persistent hypoperfusion; add hydrocortisone 200 mg/d for ongoing vasopressor need (≥ 0.25 µg/kg/min ≥ 4 h).
Key points
- Adding vasopressin is preferred over escalating norepinephrine indefinitely, sparing catecholamine dose (original synthesis · not guideline verbatim).
- A MAP target above 65 mmHg has not shown benefit and increases arrhythmia risk; permissive 60–65 is acceptable in the elderly.
- Inotropes are added to, not substituted for, vasopressors when cardiac dysfunction coexists with hypoperfusion.
References
- Evans L, et al. Surviving Sepsis Campaign 2021. Crit Care Med 2021.
- Russell JA, et al. VASST trial (vasopressin). N Engl J Med 2008.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.