Thread by @YukiKotani5

The #vasopressor session has started with 1️⃣“When is radial artery pressure unreliable?”

Detection
🔸Invasive vs Non-invasive
🔸Brain monitoring
🔸Mitral valve gradient
🔸Artery stenosis
🔸Waveform

👇Possible mechanisms of radial vs femoral differences
@ISICEM #isicem23

https://twitter.com/YukiKotani5/status/1638256892450336772

2️⃣Peripheral vasopressor use @HalliePrescott

🔸Low rates of complications reported up to 48 h with monitoring protocol

🔸Peripheral administration may avoid central line insertion (& its complications)

🔸Peripheral administration is becoming more common.

@ISICEM #isicem23

3️⃣Early #norepinephrine infusion by Prof. JL Teboul.

🔸In 2018, 12% of intensivists used early norepinephrine but experts seemed to like it.

🔸Norepinephrine may increase preload/cardiac contractility

🔸Small RCTs suggest a trend of clinical benefits

@ISICEM #isicem23

4️⃣How to promote venous constriction

👍Reduces unstressed volume and increases preload

😥Increases venous resistance and capillary leakage

💉Most vasopressors may affect venous veins.

@ISICEM #isicem23

5️⃣When to start vasopressin? @daretha75

🔸IPD meta-analysis found a reduced risk of RRT in septic shock

🔸May not promote inflammatory reactions while norepi does

🔸Studies suggest less complications in patients with early vasopressin

More data are needed!
@ISICEM #isicem23

6️⃣New vasopressor agents @KhannaAshishCCM

🔸Angiotensin 2 and renin is a hot topic🔥
Findings from ATHOS-3
Need for point-of-care assay

🔸Centhaquine: a novel alpha 2 agonists

🔸Future: RCTs for early multimodal strategy?

@ISICEM #isicem23

7️⃣Angiotensin 2 @BellomoRinaldo

🔸ATHOS3 suggests a signal toward clinical benefits in selected populations

🔸Animal studies show its immunomodulatory/ opsonizing effects

🔸decreases cardiac inflammation/injury compared with norepi

@ISICEM #isicem23

8️⃣Vasopressor test

🔸Higher MAP target in selected pts (e.g., chronic hypertension)

🔸Andromeda shock trial found difficulties in the vasopressor test (due to e.g., persistent hypotension/adverse effects)

🔸Andromeda shock 2 is ongoing in a larger scale

@ISICEM #isicem23