The critical care world is obsessed with fluid. Meanwhile, little attention has been given to the concepts of vasopressor responsiveness and vasopressor challenge.

This is a missed opportunity, because vasopressor challenges may be done more safely and precisely than fluid challenges. To develop an approach to vasopressor responsiveness in septic shock, three concepts are helpful.

The best way to determine epinephrine responsiveness may be to simply start a low dose epinephrine infusion (e.g. 4 mcg/min).

The patient’s response to epinephrine may be judged based on clinical variables. Although measuring cardiac output could also be performed, this is not my usual clinical practice.

Read More