💉 Vasoactive Agents & MAP Target in Septic Shock
UseUse after adequate fluid resuscitation to set the MAP target and choose the next vasopressor/inotrope/steroid…
SourceEvans L, et al. Surviving Sepsis Campaign 2021. Crit Care Med 2021.
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
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Methodology · worked example, guidelines & full notes
Adding vasopressin is preferred over escalating norepinephrine indefinitely, sparing catecholamine dose (original synthesis · not guideline verbatim).
When to use
Use after adequate fluid resuscitation to set the MAP target and choose the next vasopressor/inotrope/steroid step.
How it works
Initial MAP target ≥ 65 mmHg; norepinephrine first-line → add vasopressin 0.03 U/min (SSC 2021) → add epinephrine; add dobutamine (or switch to epinephrine) for cardiac dysfunction with persistent hypoperfusion; add hydrocortisone 200 mg/d (SSC 2021) for ongoing vasopressor need (≥ 0.25 µg/kg/min ≥ 4 h).
Key points
- Adding vasopressin is preferred over escalating norepinephrine indefinitely, sparing catecholamine dose (original synthesis · not guideline verbatim).
- MAP target 65 mmHg (SSC 2026 recommendation 13); age ≥ 65: 60–65 mmHg (weak recommendation, low-quality evidence; recommendation 14).
- Inotropes are added to, not substituted for, vasopressors when cardiac dysfunction coexists with hypoperfusion.
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Current MAP (after adequate fluid resuscitation) | 60 mmHg |
|---|---|
| Current vasoactive agent | Norepinephrine |
| Cardiac dysfunction with persistent hypoperfusion | No |
→MAP60 mmHg (not met)
- MAP target：Initial target MAP ≥ 65 mmHg (SSC 2026 recommendation 13; age ≥ 65: 60–65 mmHg, weak recommendation, low-quality evidence, recommendation 14). Current 60 mmHg (not met)
- Next step：Add vasopressin (~0.03 U/min, usually when norepinephrine is around 0.25–0.5 µg/kg/min) rather than simply increasing norepinephrine
- Steroid：Ongoing need for vasopressors (norepinephrine/epinephrine ≥ 0.25 µg/kg/min for ≥ 4 h) → add hydrocortisone 200 mg/d (50 mg q6h or continuous infusion; SSC 2021)
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Vasoactive Agents & MAP Target in Septic Shock?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does Vasoactive Agents & MAP Target in Septic Shock upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is Vasoactive Agents & MAP Target in Septic Shock calculated in practice? Can you show a worked example?
- Inputs: Current MAP (after adequate fluid resuscitation) 60 mmHg, Current vasoactive agent Norepinephrine, Cardiac dysfunction with persistent hypoperfusion No → Result: MAP 60 mmHg (not met)（MAP target: Initial target MAP ≥ 65 mmHg (SSC 2026 recommendation 13; age ≥ 65: 60–65 mmHg, weak recommendation, low-quality evidence, recommendation 14). Current 60 mmHg (not met), Next step: Add vasopressin (~0.03 U/min, usually when norepinephrine is around 0.25–0.5 µg/kg/min) rather than simply increasing norepinephrine, Steroid: Ongoing need for vasopressors (norepinephrine/epinephrine ≥ 0.25 µg/kg/min for ≥ 4 h) → add hydrocortisone 200 mg/d (50 mg q6h or continuous infusion; SSC 2021)）