Vasoplegic syndrome following cardiothoracic surgery—review of pathophysiology and update of treatment options

Table 2 Vasopressor titration^a

NE equivalent^b (μg/kg/min)	Vasopressin (U/min)	Methylene blue^c (mg/kg)	Angiotensin II (ng/kg/min)^d,e	Hydroxycobalamin^f (g)
If you have just titrated NE to:	Make sure vaso is:	Administer	And titrate ang II to:	Administer
< 0.05	< 0.07	No	Ang II off^c	No
0.05–0.1	< 0.07	Yes	10^c	Yes
0.1–0.15	< 0.07	Yes	20	Yes
0.15–0.20	< 0.07	Yes	30	Yes
> 0.20	< 0.07	Yes	40	Yes

^aTitration driven by NE dosing, based on MAP goals
^bNE equivalent doses represented in Table 1
^c2 mg/kg IVP over 5 min or as IVPB over 20–60 min
^dAng II maximum dose is 40 ng/kg/min
^eAlways initiate Ang II at 10 ng/kg/min. In patients who are hyper responders or extremely hemodynamically dependent on Ang II, consider titrating down Ang II to 5 ng/kg/min before titrating off
^f5 g infused over 15 min

ISSN: 1364-8535