Took care of a very sick patient recently that left me with a lingering question about the optimal course of treatment. To make a long story short, the patient had multiple acute processes, among which was kidney failure. He was placed on CRRT and left in my hands to manage. Over the course of the several days I spent with him, the patient had a very poor tolerance for any fluid removal. At first I could barely remove 50 ml/hr without significantly increased vasopressor requirements, and by the end simply having the machine running caused me to max out on my vasopressor allotment.
My question is this: in the future, should I pursue maximal vasopressor support so a patient will tolerate fluid removal?
In the early few hours when he was only maxed on two pressors I did not aggressively push for additional medication, choosing instead to reduce patient fluid removal. Was this the wrong choice? I would like to know for the future. Thank you for your time.
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