Sepsis
ICD-10 A41.9; A40.8; A40.9; A41.8 · ICD-11 1G40

Septic Shock: What to Do When Vasopressin Fails to Achieve Target MAP

This protocol covers adults with septic shock who remain haemodynamically unstable — with mean arterial pressure (MAP) below the target of 65 mm Hg — after vasopressin has been added to norepinephrine. When that combination proves insufficient, a further escalation step is indicated.

Prior Treatment Failure
Vasopressin did not achieve the haemodynamic target

The preceding step — adding vasopressin alongside norepinephrine — failed to reach the goal of a mean arterial pressure (MAP) of 65 mm Hg. This unmet target is the trigger for escalation to the present protocol.

Clinical Goal
Achieve an adequate mean arterial pressure (MAP) of 65 mm Hg.
Next-Line Approach (partial)

An additional vasopressor agent is considered at this stage to restore adequate blood pressure when the prior two-agent combination has proven insufficient.

The complete regimen, dosing guidance, and full decision algorithm are available in the structured protocol below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1097/CCM.0000000000005337

For adults with septic shock and inadequate MAP levels despite norepinephrine and vasopressin, we suggest adding epinephrine.

For adults with septic shock on vasopressors, we recommend an initial target mean arterial pressure (MAP) of 65 mm Hg over higher MAP targets.

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