A 55-year-old patient with septic shock remains hypotensive despite adequate fluid resuscitation with 30 mL/kg of crystalloid. According to the Surviving Sepsis Campaign 2021 guidelines, which vasopressor should be initiated as first-line therapy?
- A Dopamine
- B Norepinephrine ✓
- C Epinephrine
- D Vasopressin
Correct answer: B. Norepinephrine
Explanation
Norepinephrine is the recommended first-line vasopressor in septic shock because it increases mean arterial pressure primarily through vasoconstriction with minimal tachycardia. Dopamine is more arrhythmogenic and is reserved for bradycardic patients. Epinephrine is second-line and can cause tachycardia and hyperlactatemia. Vasopressin is added as a second agent to reduce norepinephrine dose. The goal MAP is at least 65 mmHg.
Reference: Surviving Sepsis Campaign Guidelines 2021, 2021 ed.
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