You’re intubating a patient who is hemodynamically tenuous, or worse, was hemodynamically stable prior to induction. After administration of the sedative they become hypotensive. In many cases, the hypotension doesn’t present immediately because of the sympathetic stimulation of the laryngoscope. But once the tube is in and things settle down, the BP starts to drop. What do you do? This is almost always a transient problem. Do you need to start a drip? Anesthesiologists and an increasing number of EM providers use something called “push dose pressors.” Little boluses of vasopressor agents that can bolster your patient’s blood pressure to get them through a transient drop. In this article on Critical Care Now, Ruben Santiago covers the Pearls and Pitfalls with Push Dose Pressors. Although he approaches this from a ED perspective, the concepts are the same for transient hypotension associated with sedation in the ICU.
critical care notes 