Phenylephrine

Never let that syringe out of your hands or eyesight until the label is securely on the syringe - Yun Cee Dursa

Phenylephrine
Phenylephrine

image by: Agnes Nana-Yaa Boachie

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Is Push Dose Phenylephrine Safe in Septic Shock?

Sometimes, as we wait for a norepinephrine drip, we may use a push-dose pressor like phenylephrine to temporarily stabilize MAP. This seems to work in many cases. Phenylephrine is often used in patients with low vascular tone, such as those in a perioperative setting, but its use in septic shock may be very different. Is use of a pure alpha-1 agonist effective and safe in these patients?

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Resources

 Is Push Dose Phenylephrine Safe in Septic Shock?

Push-dose phenylephrine improved early hemodynamic stability but was associated with increased ICU mortality in septic shock patients.

Life in the Fastlane

0.1-2mcg/kg/min (onset: minutes, duration: up to ~20 minutes)

ScienceDirect

Phenylephrine is a pure vasoconstrictor and is not recommended for empiric use, although niche uses for phenylephrine include (1) difficulty raising mean arterial pressure in the presence of high cardiac output as well as (2) serious tachyarrhythmias induced by norepinephrine (not usually an issue).

StatPearls

Phenylephrine is primarily an alpha-1 adrenergic receptor agonist with minimal to no beta-adrenergic activity; therefore, it is ideal for elevating mean arterial pressure. It does so by causing venous and arterial vasoconstriction and increasing cardiac preload without having any significant direct effect on cardiac myocytes.

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