Clinical Pearls: Pressor Selection

The foundation of critical care practice stands upon heart and lung support. As you know a multitude of problems lead to these downstream complications, but at its core what we do in the unit is handle worst case scenarios. Even for a new nurse practitioner with loads of years at the ICU bedside, pressor selection can be difficult at first. What I hear from students is “Levo, let’s just start Levo.” They say this because it has been their experience and it’s of course discussed everywhere. But when I ask them to defend the selection there can be a dearth of knowledge. Ultimately, they may be right, but I argue that as a competent provider one must have a good understanding of the pharmacodynamics of the drug AND the pathophysiology of the disorder you are treating. Why? Because while the physician/team you are practicing with currently may never question you, at some point you will need to explain your rationale. And on a baser level you need to accurately treat the problem or you could 1)chose something ineffective 2)make things worse or 3)harm the patient. Let’s talk vasopressors.