Vasopressor Use Recommendations - Michigan Medicine
Vasopressor Use Recommendations
First Line Vasopressor: Norepinephrine
Mechanism
Dose
1 agonist (strong), 1 0.01-1 mcg/kg/hr
agonist (weak)
Starting dose: 0.1 mcg/kg/min
Second Line Vasopressor: Vasopressin
Mechanism Vasopressin receptor agonist
Dose 0.03 units/minute
Third Line Vasopressor: Epinephrine
Mechanism
Dose
1 agonist (strong), 1 0.01-1 mcg/kg
agonist (moderate)
Starting dose: 0.05 mcg/kg/min
Alternative Vasopressors: Phenylephrine
Mechanism 1 agonist (weak)
Dose 50-300 mcg/min
Alternative Vasopressors: Dobutamine
Mechanism
Dose
1 agonist (moderate) 1-10 mcg/kg/min
Starting dose: 2.5 mcg/kg/min
Alternative Vasopressors: Giapreza (Angiotensin II)
Mechanism ATII receptor agonist
Dose 1.25 -40 mcg/kg/min Starting dose: 20 mcg/kg/min
Clinical Pearls - Goal mean arterial pressure (MAP) is 65 mm Hg - High MAP goals may be necessary in patients with baseline hypertension or acute
coronary syndrome - Safe to administer peripherally for up to 24 hours
Clinical Pearls - Often unnecessary in COVID patients, as they do not require high doses of
norepinephrine - May be preferred in patients with atrial arrhythmias or pulmonary hypertension
Clinical Pearls - Preferred adjunct agent in patients with low ejection fraction - Low doses (0.01-0.05 mcg/kg/min) primarily yield improved contractility - Can cause increased lactate, arrhythmias
Clinical Pearls - Safe for peripheral administration, consider in patients who cannot get central access - May be preferred in patients with atrial arrhythmias
Clinical Pearls - Consider in patients with reduced ejection fraction
Clinical Pearls - Recommend to avoid in COVID patients at this time due to unclear effects of RAAS on
COVID outcomes and VTE risk - Use in patients with refractory vasodilatory shock only
Michigan Critical Care Collaborative Network Material Attribution Author(s): Adult ICU Directors and Nick Farinas Institution or Source: Michigan Medicine
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