• Journal of critical care · Feb 2021

    Review

    Vasopressor dose equivalence: A scoping review and suggested formula.

    • Shruti Goradia, Arwa Abu Sardaneh, Sujita W Narayan, Jonathan Penm, and Asad E Patanwala.
    • The University of Sydney, Faculty of Medicine and Health, Sydney Pharmacy School, Sydney, New South Wales, Australia. Electronic address: sgor2722@uni.sydney.edu.au.
    • J Crit Care. 2021 Feb 1; 61: 233-240.

    PurposeCalculating equipotent doses between vasopressor agents is necessary in clinical practice and research pertaining to the management of shock. This scoping review summarizes conversion ratios between vasopressors and provides a formula to incorporate into study designs.Materials And MethodsMedline, Embase and Web of Science databases were searched from inception to 21st October 2020. Additional papers were obtained through bibliography searches of retrieved articles. Two investigators assessed articles for eligibility. Clinical trials comparing the potency of at least two intravenous vasopressors (norepinephrine, epinephrine, dopamine, phenylephrine, vasopressin, metaraminol or angiotensin II), with regard to an outcome of blood pressure, were selected.ResultsOf 16,315 articles, 21 were included for synthesis. The range of conversion ratios equivalent to one unit of norepinephrine were: epinephrine (0.7-1.4), dopamine (75.2-144.4), metaraminol (8.3), phenylephrine (1.1-16.3), vasopressin (0.3-0.4) and angiotensin II (0.07-0.13). The following formula may be considered for the calculation of norepinephrine equivalents (NE) (all in mcg/kg/min, except vasopressin in units/min): NE = norepinephrine + epinephrine + phenylephrine/10 + dopamine/100 + metaraminol/8 + vasopressin*2.5 + angiotensin II*10.ConclusionA summary of equipotent ratios for common vasopressors used in clinical practice has been provided. Our formula may be considered to calculate NE for studies in the intensive care unit.Copyright © 2020 Elsevier Inc. All rights reserved.

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