In septic shock, restoring adequate perfusion pressure is a core resuscitation priority. When the initial vasopressor regimen does not reach the target mean arterial pressure (MAP), a defined escalation step — rather than simple dose escalation — guides the next clinical decision.
The first-line approach uses norepinephrine as the primary vasopressor (with epinephrine or dopamine as alternatives when norepinephrine is unavailable). Escalation to this protocol is triggered when that approach fails to achieve the initial target MAP of 65 mm Hg.
Achieve and maintain an adequate mean arterial pressure (MAP) of 65 mm Hg.
When the MAP target is not met on norepinephrine, the protocol directs the addition of a second vasopressor agent rather than continuing to escalate the norepinephrine infusion. The specific agent, timing criteria, and full administration approach are detailed in the structured regimen.
DOI: 10.1097/CCM.0000000000005337