Question of the Week

Question :
Posted On : 28 Aug 2018
hi.In shock management when we shift from Dopamine to epinep or norepinep. do we continue to use dopa simulatneously or remove it. and in pt. with tachycardia with shock the order of ionotropes should be_?_?.. dopa it self causes tachycardia , so should the first choice be dobutamine_?_?_?
Expert Answer :
Current consensus recommendations from 11 different societies in the Surviving Sepsis Campaign guidelines recommend either Dopamine as the initial vasopressor for patients with septic shock in children. Dopamine was the traditional vasopressor choice for shock management, until recent reports of Dopamine resistance and, or its potential for tachyarrhythmias resulted in norepinephrine`s emergence as the preferred initial vasopressor in North America and Europe in adults. In case of cardiogenic shock, Dobutamine is preferred. Combination vasopressors have not shown to be more effective.
Answer Discussion :
Sandeep Rao
ideally after 48-72 hrs..due to tachyphylaxis dopamine no longer works..ideally go for 2nd ionotrope..but depends on the warm shock -NorA,in cold shock Adrenaline,in cardiogenic shock-dobut,milrenone
.add one of these accordingly,,taper&stop dopa..before starting ionotrope 3 fluid boluses 20ml/kg can be given...Noradr causes least tachycardia..

3 years ago
abid ali
Withdraw dopamine gradually, if shock and tachycardia is due to sepsis than use noradrenaline and if due to myocarditis use milrinone, in most of the cases we can combine inotropes
3 years ago
Mohamed BAYARI
withdraw gradually as E or NE is being efficacious
In septic shock, use NE

3 years ago
kadri soliman
Yes I agree to use donut amine and withdraw gradually
3 years ago
Dobutamine will be first choice... but Dopamine may be used and withdraw continuously if patient feel better or responses
3 years ago

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