Levophed (Norepinephrine)

Ever since the NEJM put out its big RCT on the treatment of all-comer shock, we know that norepinephrine is the vasopressor of choice. Septic, cardiogenic….doesn’t matter - Jay Khadpe MD

Levophed (Norepinephrine)
Levophed (Norepinephrine)

image by: اسأل دكتور ومتسألش حد تاني O.o

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A Paradigm shift: re-thinking sepsis, and maybe shock in general

My (very) humble opinion on this is a rather simple, almost philosophical one: why are we seemingly obsessed with treating a predominantly vasodilatory pathology with large amounts of volume? I’ve said this in previous posts and podcasts, but this, in my opinion, is largely cultural and dogmatic. “Levophed – Leave’em dead” is something I heard as a student and resident, and came to take for granted that I should give lots of fluid in hopes of avoiding pressors… But there’s no evidence at all to support this. The common behavior of waiting until someone has clearly failed volume resuscitation before starting pressors befuddles me (think how long it takes to get two liters of fluid in most ERs…).…

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 A Paradigm shift: re-thinking sepsis, and maybe shock in general

My (very) humble opinion on this is a rather simple, almost philosophical one: why are we seemingly obsessed with treating a predominantly vasodilatory pathology with large amounts of volume? I’ve said this in previous posts and podcasts, but this, in my opinion, is largely cultural and dogmatic. “Levophed – Leave’em dead” is something I heard as a student and resident, and came to take for granted that I should give lots of fluid in hopes of avoiding pressors… But there’s no evidence at all to support this.

Picmonic

Norepinephrine (Levophed) is an adrenergic agonist with alpha-1, alpha-2, and beta-1 specificity.

StatPearls

Norepinephrine's predominant use is as a peripheral vasoconstrictor. Specifically, the FDA has approved its use for blood pressure control in specific acute hypotensive states, as well as being a potential adjunct in the treatment of cardiac arrest with profound hypotension. Also, norepinephrine generally has more predictive pharmacologic properties than other alpha agonists. This predictive quality, in combination with some of its beta-agonism (which improves cardiac function relative to pure alpha agonists), makes norepinephrine a widely used vasoactive agent.

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