There is no maximum dose of norepinephrine, but it should be the rare time you need to get to high doses. Join this channel to get access to perks: / @salimrezaie
TY very much and glad it was useful. We have had this issue/conundrum come up several times and no one could give me a clear answer so I did a search myself to see what the available evidence is.
I like the slide about workup of refractory shock, will add TSH if (low Temp, bradycardia, hypoglycemia) and a good bedside eFAST (cardiac/lungs/abd/BLE veins) as sometimes these patients are very unstable to go for stat panCT
Often times people try to make numbers look better but don't go searching for the etiology. That slide was not meant to be all encompassing but a start...love your additions
Thank you Dr. Rezai. Amazing talk as always. Although I start vaso and hydrocort at 0.3mic/kg of nor epi but the max dose in our hospital protocol is 2 mics/kg/min. Same goes for epi
Suspect there is room for clinical judgment when it comes time to start second agent and steroids…but seems we are close in our clinical practice…and pretty awesome about the 2mcg/kg/min…ours is set at 0.5mcg/kg/min but seems it is an arbitrary cutoff
Great and amazing review In our hospital Noard maximum dose 1mic Of course if you exceed .02 mic second agent should be started And the most important is to know and correct the cause My first time to review all of this study
I love this video. Unfortunately no RCTs guide us to max out the dose to a certain number. It all depends… like what kind of shock, how pt responds to levophed , any other vosopressors to be added on as a back up ? Etc etc… what a good video , thank you.
TY so much...not sure there is a great answer to this, but good to know that it is possible to get to higher doses and people still survive without major issues. Would also argue that the search for etiology/causes of shock so crucial rather than just cranking up a dose of a medication to make a number look better. TY for watching and taking the time to comment.
no bullshit! right to what matters and what to do, made so simple in under 8 minutes, amazing, great job, ty
TY so much and glad you found it helpful. :)
It is first time i listened to your vedio…worth listening very informative
I have suggested my whole icu team to listen this
TY very much and glad it was useful. We have had this issue/conundrum come up several times and no one could give me a clear answer so I did a search myself to see what the available evidence is.
@@SalimRezaie well appreciated efforts
I like the slide about workup of refractory shock, will add TSH if (low Temp, bradycardia, hypoglycemia) and a good bedside eFAST (cardiac/lungs/abd/BLE veins) as sometimes these patients are very unstable to go for stat panCT
Often times people try to make numbers look better but don't go searching for the etiology. That slide was not meant to be all encompassing but a start...love your additions
Thank you Dr. Rezai. Amazing talk as always. Although I start vaso and hydrocort at 0.3mic/kg of nor epi but the max dose in our hospital protocol is 2 mics/kg/min. Same goes for epi
Suspect there is room for clinical judgment when it comes time to start second agent and steroids…but seems we are close in our clinical practice…and pretty awesome about the 2mcg/kg/min…ours is set at 0.5mcg/kg/min but seems it is an arbitrary cutoff
Great and amazing review
In our hospital
Noard maximum dose 1mic
Of course if you exceed .02 mic second agent should be started
And the most important is to know and correct the cause
My first time to review all of this study
Thank you 🙏…ours is arbitrarily set at 0.5mcg/kg/min of norepinephrine…but 100% agree with knowing the cause and correcting it
You are amazing keep going please
Very much appreciated.
I love this video. Unfortunately no RCTs guide us to max out the dose to a certain number. It all depends… like what kind of shock, how pt responds to levophed , any other vosopressors to be added on as a back up ? Etc etc… what a good video , thank you.
TY so much...not sure there is a great answer to this, but good to know that it is possible to get to higher doses and people still survive without major issues. Would also argue that the search for etiology/causes of shock so crucial rather than just cranking up a dose of a medication to make a number look better. TY for watching and taking the time to comment.