Intensive care medicine in 2050: vasopressors in sepsis

Excerpt

Vasopressors are used in sepsis when hypotension is assumed to be mainly due to a decreased arterial tone. However, the appropriate time to initiate vasopressors is not clearly defined, and fluid administration is most often prioritized [1] with potential risks of fluid overload and persistent hypotension, all events associated with increased mortality. We thus need relevant easy-to-obtain markers of decreased arterial tone to appropriately initiate a vasopressor. The diastolic arterial pressure (DAP) is the simplest bedside marker of vasomotor tone, especially in patients with tachycardia. In such cases, the diastolic time is reduced such that DAP should be higher than normal for a normal arterial tone. Therefore, a low DAP (e.g., <40 mmHg) in this context suggests a depressed arterial tone. Other markers such as the dynamic arterial elastance [2] might also help in the future to trigger initiation of vasopressors. …