PMC4969285_01
Vasopressor and fluid resuscitation support needed to maintain a minimum mean arterial pressure (MAP) of 40 mmHg. The kinetics of the mean arterial blood pressure as determined by non-invasive blood pressure (NIBP) "cuff" (blue line) and continuous invasive blood pressure (CIBP) "arterial line" (red line) (A). The dosing of vasopressors, expressed as vasopressor potency, against time (B). Given their higher biologic activity, vasopressor potency for epinephrine (red line) and norepinephrine (green line) were calculated as the dose (mug/kg/min) x 100, whereas the vasopressor potency of dobutamine (blue line) was calculated as simply the dose of dobutamine (microgram per kilogram per minute). Ongoing fluid resuscitation using both colloid (5% albumin in NS) and blood products (including packed red blood cells and fresh frozen plasma) needed to maintain a minimum MAP of 40 mmHg (dotted line) (C).
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F1
The patient's respiratory and hemodynamic profile continued to deteriorate (Figure 1A) in spite of escalating vasopressor support (Figure 1B), and the patient needed repeated fluid boluses of colloid (5% human serum albumin in NS) and blood product administration (Figure 1C) to maintain mean arterial pressure (MAP) of at least 40 mmHg. At this time, 30 mg/kg methylprednisolone was administered to ameliorate the inflammatory process and, with the addition of norepinephrine, the patient stabilized transiently, and we were able to wean the epinephrine support slightly (Figure 1B).