Pressors
HR: heart rate; CO: cardiac output
SVR: systemic vascular resistance
PVR: pulmonary vascular resistance
The chart accounts for the LLU NICU Manual dosages - I did my best to ensure the chart reflects the physiologic effects of the above agents at our institution's dosing ranges
Cells highlighted in yellow represent most important effect (i.e. why you're using the drug)
I would not pay too much attention to the "Inotropy" and "Heart Rate" columns as there is conflicting information in the different articles I looked up
Cardiac output is the variable you're most likely trying to modulate, so would refer to that when picking an agent
Hydrocortisone
Test dose 1 mg/kg; if no further rise in BP after 2-4 h: no further dosing
If BP increases within 2-4h
≤34 wks: 0.5 mg/kg/dose q 12h
>34 wks: 0.5 mg/kg/dose q 6-8h
Similarly to vasopressin, it is an adjunct for refractory hypotension
Hydrocortisone potentiates catecholamine function by:
Decreased catecholamine breakdown
Upregulation of adrenergic receptors
Increased myocardial calcium absorption
Vasopressin
Antidiuretic, so leads to water retention; monitor BMP q6hr for hyponatremia
To wean off, decrease rate by half q2hr until off
Do not discontinue abruptly as can cause hypotension