A 58-year-old man on ICU has septic shock and acute cor pulmonale from ARDS (RV dilatation, D-shaped LV on echo). His MAP is 55 mmHg despite noradrena...

Question

A 58-year-old man on ICU has septic shock and acute cor pulmonale from ARDS (RV dilatation, D-shaped LV on echo). His MAP is 55 mmHg despite noradrenaline 0.4 mcg/kg/min. What is the recommended vasopressor strategy for concurrent vasodilatory shock with acute RV failure?

Accepted Answer

Noradrenaline remains first-line - it maintains coronary perfusion pressure (essential for RV perfusion which occurs during systole AND diastole) and provides systemic vasoconstriction; avoid excessive fluid loading which will worsen RV distension; consider inhaled pulmonary vasodilators (iNO/iEPO) to reduce RV afterload selectively

Answer

Add dobutamine to improve RV contractility

Answer

Switch entirely to vasopressin

Answer

Stop all vasopressors and fluid restrict

Answer

Adrenaline is contraindicated in RV failure

uk-fficm MCQ (SBA): Vasodilatory Shock with RV Failure

A 58-year-old man on ICU has septic shock and acute cor pulmonale from ARDS (RV dilatation, D-shaped LV on echo). His MAP is 55 mmHg despite noradrenaline 0.4 mcg/kg/min. What is the recommended vasopressor strategy for concurrent vasodilatory shock with acute RV failure?