Initial pressor agents for septic shock

How to select initial pressor agents for patients in septic shock? 

For patients with evidence of shock refractory to adequate fluid resuscitation, dopamine is started initially if the patient is normotensive. For patients who are hypotensive, norepinephrine is the agent of choice when systemic vascular resistance (SVR) is low (warm shock), and epinephrine (< 0.3 μg/kg/minute) and dopamine (< 10 μg/kg/minute) are the agents of choice when SVR is elevated (cold shock). 


Brierley J, Carcillo JA, Choong K, et al: Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Crit Care Med 2009;37(2):666-688.


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