What is the treatment for hypotension?

From the Guidelines

Treatment of Hypotension

Hypotension should be treated immediately, with the most appropriate management involving a bedside assessment to define the cause and treat accordingly 1.

• The treatment approach should be based on the presumed underlying causes, including vasodilation, hypovolaemia, bradycardia, and low cardiac output 1.
• Administering intravenous fluids, such as normal saline or lactated Ringer's solution, at an initial rate of 500-1000 mL over 30 minutes is a common initial treatment for hypotension.
• If hypotension persists, pharmacological interventions may be initiated, including:
  • Norepinephrine at a starting dose of 0.05-0.1 mcg/kg/min, titrated to achieve a mean arterial pressure of 65 mmHg or higher 1.
  • Phenylephrine at a dose of 0.5-1.5 mcg/kg/min, with treatment duration and dosage adjusted based on individual patient response and clinical status 1.
• In cases of cardiogenic shock, individualized mean arterial pressure (MAP) goals are required, and inotropes such as dobutamine may be used as the first-line agent 1.
• A passive leg raise (PLR) test should be considered for patients with postoperative hypotension to assess fluid responsiveness 1.
• The side-effect profile of drugs used in the treatment of hypotension must be taken into account, and treatment should be tailored to the individual patient's response and clinical status 1.

From the FDA Drug Label

DOSAGE & ADMINISTRATION Norepinephrine Bitartrate Injection is a concentrated, potent drug which must be diluted in dextrose containing solutions prior to infusion. An infusion of LEVOPHED should be given into a large vein (see PRECAUTIONS) Restoration of Blood Pressure in Acute Hypotensive States Blood volume depletion should always be corrected as fully as possible before any vasopressor is administered. When, as an emergency measure, intraaortic pressures must be maintained to prevent cerebral or coronary artery ischemia, LEVOPHED can be administered before and concurrently with blood volume replacement INDICATIONS & USAGE For blood pressure control in certain acute hypotensive states (e.g., pheochromocytomectomy, sympathectomy, poliomyelitis, spinal anesthesia, myocardial infarction, septicemia, blood transfusion, and drug reactions). As an adjunct in the treatment of cardiac arrest and profound hypotension.

The treatment for hypotension is norepinephrine (IV) administration, with the goal of maintaining a low normal blood pressure (usually 80 mm Hg to 100 mm Hg systolic) sufficient to maintain the circulation to vital organs 2. Blood volume depletion should be corrected as fully as possible before any vasopressor is administered 2.

• The average maintenance dose ranges from 0.5 mL to 1 mL per minute (from 2 mcg to 4 mcg of base) 2.
• Central venous pressure monitoring is usually helpful in detecting and treating occult blood volume depletion 2.
• Fluid intake should be managed based on clinical fluid volume requirements 2.
• Duration of therapy should be continued until adequate blood pressure and tissue perfusion are maintained without therapy, with gradual reduction of the infusion to avoid abrupt withdrawal 2.

From the Research

Treatment Options for Hypotension

The treatment for hypotension can vary depending on the underlying cause and severity of the condition. Some studies suggest the following options:

• Push-dose vasopressin as an alternate vasoactive medication to improve hemodynamics in patients with vasodilatory septic shock 3
• Hypertonic saline dextran (HSD) for the treatment of haemorrhagic hypotension, which can rapidly expand plasma volume and stabilize haemodynamic variables 4
• Titrated hypertonic/hyperoncotic solution for hypotensive fluid resuscitation during uncontrolled hemorrhagic shock, which can maintain controlled hypotension with a reduced volume of fluid required 5
• Ephedrine as the vasopressor of choice for treatment of hypotension during ritodrine infusion and epidural anesthesia, as it can restore uterine blood flow and fetal oxygenation 6
• Normal saline as an effective treatment for neonatal hypotension, with comparable efficacy to 5% albumin 7

Fluid Resuscitation

Fluid resuscitation is a common approach to treating hypotension, and the choice of fluid can depend on the underlying cause of the condition. Some studies suggest:

• Lactated Ringer's solution as a common fluid for resuscitation, but it may require larger volumes to achieve the same effect as hypertonic solutions 3, 5
• Hypertonic saline dextran (HSD) as a potential alternative to conventional fluid therapy, with advantages in terms of volume and logistics 4
• Normal saline as a suitable option for volume expansion in neonatal hypotension, with comparable efficacy to 5% albumin 7

Vasoactive Medications

Vasoactive medications can be used to support blood pressure in patients with hypotension. Some studies suggest:

• Push-dose vasopressin as an effective treatment for hypotension in patients with vasodilatory septic shock 3
• Ephedrine as a suitable option for treating hypotension during ritodrine infusion and epidural anesthesia, with benefits for uterine blood flow and fetal oxygenation 6
• Phenylephrine as an alternative vasopressor, but it may not be as effective as ephedrine in restoring uterine blood flow and fetal oxygenation 6