Bibliographic information
Guideline—
Year of Publication—
Issuing Institution—
Recommendation
New
WHO recommends that patients with suspected or confirmed filovirus disease requiring a vasopressor be treated with norepinephrine rather than dopamine.
Recommended in favor
Strong
Certainty of evidence
Moderate
Notes and Remarks
- This recommendation applies to children and adults, including pregnant women. • Vasopressors should be used within a resuscitation strategy that includes: appropriate intravenous fluid therapy; frequent monitoring, including for cardiac arrhythmia. • Individualize titration of the dose to desired effect (targeting arterial pressure as an indicator of perfusion). • To minimize adverse effects, use the lowest dose possible for desired effect and discontinue vasopressors when no longer indicated. Practical info General considerations
- Establish large bore veinous access (16–18 gauge catheter) or intraosseous line or central venous catheter.
- Appropriate dilution in selected carrier and precise delivery mechanism, such as infusion pumps.
- Establish close haemodynamic monitoring, and adequate staffing to provide close monitoring.
- Close monitoring of the intravenous site is mandatory to identify any signs of extravasation:
- lf signs of extravasation, administer 5–10 mL of phentolamine diluted in 10 mL of 0.9% sodium chloride subcutaneously at the venous access site.
- Use the lowest dose necessary to achieve perfusion target. Check markers of perfusion every 30 minutes. To make up norepinephrine and epinephrine solutions:
- Adults: add 4 mL of 1:1000 norepinephrine/epinephrine to 46 mL of 5% w/v dextrose solution to make 50 mL of 80 µg/mL concentration.
- Children: use a more dilute solutions. Add 1 mL of 1:1000 norepinephrine/epinephrine to 49 mL of 5% w/v dextrose solution to make 50 mL of 20 µg/mL concentration.
- Peripheral administration: use a more dilute solution (equivalent to that used centrally for children). Add 1 mL of 1:1000 norepinephrine to 49 mL of 5% w/v dextrose solution to make 50 mL of 20 µg/mL concentration. For both norepinephrine and epinephrine administered through a central vein, start at 0.05 μg/kg/min and increase the dose in increments of 0.1 μg/kg/min, up to a maximum of 0.5–0.75 μg/kg/min. When administered through a peripheral vein, use the same dosing regimen but prepare a dilute solution with a concentration of 20 μg/mL.