Overview
The Clinical Problem
Low blood pressure is a sign of impaired circulation, not a diagnosis.
Low blood pressure is a sign of impaired circulation, not a diagnosis. Before selecting or increasing a vasopressor, determine whether the patient needs volume replacement, treatment of the underlying cause, or both. For septic shock, norepinephrine is the first-line vasopressor after adequate fluid resuscitation. It raises vascular tone and supports a mean arterial pressure (MAP) target of at least 65 mm Hg while treatment of the infection and source of shock continues. Safe use depends on three linked decisions: identify the shock pattern, titrate the infusion to the prescribed haemodynamic target, and judge success by tissue perfusion rather than the blood-pressure number alone. A higher MAP is not reassuring if urine output is falling, lactate is rising, or the fingers and toes are becoming pale and cold.