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Vasopressor Weaning — FRCA Final MCQ

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EasyIntensive Care MedicineVasopressor WeaningFRCA Final

An adult with resolving septic shock has received a noradrenaline infusion for 4 days. The patient is adequately volume resuscitated, has normal lactate and warm peripheries, and is maintaining the individualised target mean arterial pressure on 0.15 micrograms/kg/min. What is the most appropriate approach to withdrawing the noradrenaline?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Reduce the infusion in small stepwise decrements, reassessing blood pressure and tissue perfusion after each change

Explanation lettering: B = shown as A · E = shown as B · D = shown as C · A = shown as D · C = shown as E

Noradrenaline has a very short plasma half-life, so its pressor effect is lost within minutes of a rate change; the UK SmPC therefore states the infusion should be decreased gradually because abrupt withdrawal can cause acute hypotension, with blood pressure monitored frequently and dose titrated to the observed pressor response. Weaning is response-guided: small stepwise reductions with reassessment of mean arterial pressure and perfusion (lactate, capillary refill, urine output) after each step. Immediate cessation (A) risks rebound hypotension and recurrent organ hypoperfusion. A mandated 50% hourly reduction (B) is an arbitrary fixed schedule that ignores the haemodynamic response. Midodrine (D) is not routinely required and the evidence for accelerating weaning is weak. Adrenaline (E) offers no weaning advantage and adds tachyarrhythmia and lactataemia risk.

Reference: Electronic Medicines Compendium (UK). Noradrenaline (Norepinephrine) 1 mg/ml Concentrate for Solution for Infusion — SmPC, section 4.2 (Posology and method of administration; withdrawal of therapy). https://www.medicines.org.uk/emc/product/4115/smpc