Phenylephrine vs. Catecholamines and the (rodent) heart

Okay, I don’t normally blog about animal studies, but I thought this would be of interest, particularly to readers of my post ‘Why I don’t give vasopressors in sepsis’ which was followed by some interesting debate between friends Scott, Minh, Aaron and Pete. It supports my view that pure alpha-agonists might fix the numbers on … Continue reading Phenylephrine vs. Catecholamines and the (rodent) heart

Why I don’t give vasopressors in sepsis

It’s become popular to use the term ‘vasopressors’ or just ‘pressors’ when noradrenaline/norepinephrine or even (in some places still) dopamine are given. I have resisted this trend and continue to use the term ‘vasoactive’ drugs, on the basis that the effects they produce (and that we may desire) are not limited to a pure alpha … Continue reading Why I don’t give vasopressors in sepsis

An easily missed cause of shock

A potentially reversible cause of haemodynamic shock in critically ill patients is left ventricular outflow tract obstruction (LVOTO). We are familiar with this phenomenon in conditions such as hypertrophic cardiomyopathy (HCM), but LVOTO can occur in the absence of HCM and result in hypotension that may be refractory to catecholamines. In fact, vasoactive drugs are … Continue reading An easily missed cause of shock

Peripheral vasoactive infusions

It is often recommended that vasoactive agents are infused via central lines because of the risk of infiltration and tissue injury. The Children’s Hospital Boston transport team describe transport of 73 infants and children who were treated during interhospital transport with vasoactive medications via a peripheral intravenous line. Median transport time was only 38 minutes … Continue reading Peripheral vasoactive infusions