Vasopressor Selection and Safety Monitoring

Shock is not simply a low blood-pressure reading; it is inadequate tissue perfusion that threatens the brain, kidneys, heart, and other organs. A vasopressor temporarily supports circulation while the cause of shock is identified and treated. For adult septic shock, norepinephrine is the first-line vasopressor after adequate fluid resuscitation, with an initial target MAP of at least 65 mm Hg. It works mainly by increasing vascular tone through α1-adrenergic vasoconstriction. The safe clinical loop is to identify the shock phenotype, assess volume status and cardiac function, start the prescribed infusion through the safest available access, titrate to the pressure target, and reassess organ perfusion after every change. A higher MAP is not enough if urine output falls, lactate rises, mental status worsens, or peripheral and abdominal findings suggest ischemia. Do not automatically apply the septic-shock default to haemorrhage, cardiogenic shock, or obstructive shock. The cause, fluid response, ventricular function, rhythm, and local critical-care protocol determine whether norepinephrine is appropriate and what additional therapy is required.