What is the first-line vasopressor treatment for septic shock?

The first-line vasopressor treatment for septic shock is norepinephrine. Norepinephrine works primarily by causing vasoconstriction, which increases systemic vascular resistance and subsequently raises blood pressure. This is crucial in septic shock, where patients often experience profound vasodilation and reduced perfusion to vital organs due to sepsis-induced hypotension.

Norepinephrine is preferred due to its efficacy in improving hemodynamic instability with a relatively favorable side effect profile compared to other vasopressors. It not only enhances vascular tone but also has some inotropic effects, which may be beneficial in supporting cardiac function during septic shock.

While dopamine, epinephrine, and phenylephrine can be used in various scenarios of shock, they are not considered the first-line agents for septic shock. For instance, dopamine is generally avoided due to its variable effects on blood pressure based on dose. Epinephrine is often reserved for cases of anaphylactic shock or when higher levels of cardiac stimulation are required. Phenylephrine, being a pure alpha-agonist, can lead to reflex bradycardia and is less favored in septic states where inotropic support may also be desirable.