💉 Vasoactive Agents & MAP Target in Septic Shock
Vasoactive-agent and MAP-target framework for septic shock, following the Surviving Sepsis Campaign escalation sequence.
Adding vasopressin is preferred over escalating norepinephrine indefinitely, sparing catecholamine dose (original synthesis · not guideline verbatim).
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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.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Current MAP (after adequate fluid resuscitation) | 60 mmHg |
|---|---|
| Current vasoactive agent | None |
| Cardiac dysfunction with persistent hypoperfusion | No |
→MAP60 mmHg (not met)
- MAP target：Initial target MAP ≥ 65 mmHg (not superior to higher targets; permissive hypotension 60–65 acceptable in the elderly). Current 60 mmHg (not met)
- Next step：Norepinephrine first-line, titrate to MAP ≥ 65 mmHg
- Drug tips：Norepinephrine is preferred with tachyarrhythmia; epinephrine may be preferred with bradyarrhythmia. Once the target is met, use the lowest effective dose and avoid prolonged high-dose norepinephrine
Frequently asked questions
- What is Vasoactive Agents & MAP Target in Septic Shock?
- Vasoactive-agent and MAP-target framework for septic shock, following the Surviving Sepsis Campaign escalation sequence.
- How is Vasoactive Agents & MAP Target in Septic Shock calculated? What is the core formula?
- 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).
- When is Vasoactive Agents & MAP Target in Septic Shock used?
- Use after adequate fluid resuscitation to set the MAP target and choose the next vasopressor/inotrope/steroid step.
- What are the key clinical points for Vasoactive Agents & MAP Target in Septic Shock?
- 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.
- What are the limits and cautions when using Vasoactive Agents & MAP Target in Septic Shock?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is Vasoactive Agents & MAP Target in Septic Shock calculated in practice? Can you show a worked example?
- Inputs: Current MAP (after adequate fluid resuscitation) 60 mmHg, Current vasoactive agent None, Cardiac dysfunction with persistent hypoperfusion No → Result: MAP 60 mmHg (not met)（MAP target: Initial target MAP ≥ 65 mmHg (not superior to higher targets; permissive hypotension 60–65 acceptable in the elderly). Current 60 mmHg (not met), Next step: Norepinephrine first-line, titrate to MAP ≥ 65 mmHg, Drug tips: Norepinephrine is preferred with tachyarrhythmia; epinephrine may be preferred with bradyarrhythmia. Once the target is met, use the lowest effective dose and avoid prolonged high-dose norepinephrine）