Let’s go through common drips you will see in any ICU.
SEDATION
Propofol
Dosage: 5-80 mcg/kg/min
Titrated based on RASS
Fentanyl – synthetic derivative of Morphine/ 50-100x more potent than Morphine
Dosage: 25-100 mcg (up to 300 mcg)
Titrated based on BPS
Dilaudid: 5x more potent than Morphine. Metabolized in liver so reduce dose in hepatic dysfunction.
Dosage: 0.2-4 mg/hr
Titrated based on BPS
Pressors
NOREPINEPHRINE/
LEVOPHED
Receptor: Alpha 1 + Beta 1
Causes vasoconstriction + increase in CO
Can be weight based (cardiac surgery) or non-weight based dosages
Non-weight: 2-100 mcg/min
PHENYLEPHRINE/
NEO-SYNEPHRINE
Pure Alpha 1 = Vasoconstriction
Useful in hypotension with SVR < 700 dynes/-sec/cm5
Weight based (CSU) & Non-weight based Dosages:
Non-weight: 20-300 mcg/min
VASOPRESSIN (antidiuretic hormone)
Dosage: 0-0.06 units/min
Helpful in vasodilatory shock & as 2nd pressor
DOPAMINE
Dose dependent
Can cause tachyarrhythmias
Dose: 1-2 mcg/kg/min – acts mainly on D-1 receptors in kidney, mesenteric, cerebral, & coronary beds = selective vasodilation. These dosages are also used for renal protection to help UOP.
5 to 10 mcg/kg/min: Also stimulates beta-1 receptors & increases CO, mainly by increasing SV with variable effects on HR.
>10 mcg/kg/min: Predominant effect is to stimulate alpha receptors & produce vasoconstriction with an increased SVR
INOTROPES
EPINEPRHINE:
Receptors: Beta 1 + Moderate Beta 2 + Alpha 1
Low doses increases CO
Weight & Non-weight based:
Non-weight dosage: 0-20 mcg/min
DOBUTAMINE: Weight-Based
Vasodilation
Dоbսtаminе’s beta-1 receptor effect increases inotropy & chronotropy & reduces LV filling pressures. In heart failure, this results in reduced cardiac sympathetic activity. However, its minimal alpha & beta-2 adrenergic receptor effects result in vasodilation. The end result is increased CO, with decreased SVR with or without a small reduction in blood pressure.
Dosage: 2.5-10 mcg/kg/min
Manaker, S., & Teja, B. (n.d.). UpToDate. UpToDate. https://www.uptodate.com/contents/use-of-vasopressors-and-inotropes?search=norepinephrine&source=search_result&selectedTitle=2%7E150&usage_type=default&display_rank=1#H21