Vasopressin is a second vasopressor, not a replacement for noradrenaline. The Surviving Sepsis Campaign suggests adding it, rather than escalating noradrenaline further, once noradrenaline reaches roughly 0.25–0.5 µg/kg/min. It is given at a fixed dose, usually 0.03 units/min, and is not titrated like a catecholamine. Higher doses raise the risk of digital and mesenteric ischaemia.
- Start when noradrenaline is about 0.25–0.5 µg/kg/min
- Fixed dose 0.03 units/min
- Do not titrate upwards to chase MAP
- Check fingers, toes and lactate after starting
Why it matters
With premixed bags under recall, getting the dose right in a locally prepared infusion matters more.
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