The use of vasopressors is a double-edged sword. While improving perfusion pressure in the large vessels, they may decrease capillary blood flow in certain tissue beds. Vasopressors also may alter the relationship between volume and pressure measurements through their effect on the pulmonary and peripheral vascular beds. In other words, vasopressors will falsely elevate CVP and pulmonary artery occlusion pressure. They should be used judiciously, generally only after volume resuscitation. When multiple vasopressors are used, they should be simplified as soon as the most therapeutic vasopressor is identified. Volume resuscitation and intravascular volume assessment should be a dynamic process. This will increase the opportunity for the earliest possible discontinuation of vasopressor.
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