Understanding patient-centredness: contrasting expert versus patient perspectives on vasopressor therapy for shock

Excerpt

In septic shock, we use vasopressors under the assumption that they improve organ perfusion. The vasoconstricting effect should be limited in intensity, only enough to compensate for excessive arterial vasodilatation or to mobilize blood pooled in venous capacitance vessels. In other types of shock, vasopressors are used as bridge therapy for profound hypotension to induce vasoconstriction predominantly in ‘less vital organs’, redistributing blood flow to ‘more vital’ organs [1]. Thus, when we administer vasopressors, we postulate that we control the intensity and the distribution of the vasoconstrictive effect. Poiseuille’s law suggests that we might frequently be wrong as vasoconstriction is more likely to reduce blood flow despite higher blood pressure values. However, even when we are not wrong, a number of unavoidable trade-offs may be associated with short- and long-term adverse effects (Table 1). …