ICU Infusions and Inotropes

Syringe pump dilutions and titration rates for vasopressors and ICU infusions · v1.9

  • Enter the patient weight, then pick the drug from the search box or the class chips.
  • You get what to make up and in which solvent, the starting pump rate in mL/hr, and the loading dose with its ceiling where the drug has one.
  • You also get a titration grid across the usual range, read in mL/hr.
  • You do not enter a rate. The tool prints the standard starting dose and you titrate from there.
  • Every figure assumes the drug is made up to 50 mL, or to the stated standard volume, in the solvent named, and is delivered by syringe pump.

  • Children, and any adult below 20 kg or above 300 kg. Every rate here is per kilogram and the weight field refuses a figure outside that range.
  • The choice of drug. It works out the infusion you have already chosen, and does not say whether this is the right agent or whether an infusion is needed at all.
  • Any agent outside the thirty in the picker, and any dilution other than the standard one named for each of them.
  • Dose reduction for renal or hepatic failure. No infusion here is adjusted for organ failure; the drug notes flag which agents accumulate and leave the reduction to you.
  • Compatibility between two drugs sharing one lumen. Each protocol is written for its own syringe, and nothing here says what may run alongside it.

1. Patient Parameters

2. Select Infusion

The ward name matches as well as the label name. Leave it blank and use the class filter instead.

Indian Clinical Context & Points to Note

Read the ampoule before you draw up. Strength and packaging vary between manufacturers and between hospitals, and every protocol below is written as a total dose in the syringe rather than a number of ampoules.

  • Noradrenaline Ampoules: Highly variable. Check if the ampoule contains 2 mg in 2 ml or 4 mg in 2 ml. The protocol requires a total of 4 mg (Single) or 8 mg (Double) in the syringe.
  • Amiodarone Diluent: Dilute in 5% Dextrose only. Saline causes immediate precipitation. PVC bags absorb the drug, so use a glass bottle or a polyolefin bag where one is available.
  • Vasopressin: Do not titrate like Noradrenaline. It acts on V1 receptors to restore vascular tone and is used at a fixed rate of 0.04 units/min.

1. Illness Scripts: Vasopressor Selection

Clinical State First Line Rationale
Septic Shock Noradrenaline Potent alpha-1 agonism restores systemic vascular resistance (SVR) without the extreme tachyarrhythmia risk of Dopamine. Add Vasopressin if > 0.25-0.5 microgram/kg/min required.
Cardiogenic Shock Noradrenaline + Dobutamine Noradrenaline maintains MAP for coronary perfusion; Dobutamine provides inotropy. Dopamine is restricted due to higher mortality in cardiogenic shock.
Anaphylactic Shock Adrenaline Mixed alpha and beta agonism. Relieves bronchospasm, reduces mast cell degranulation, and supports cardiac output and SVR simultaneously.

2. Haemodynamic Targets: Surviving Sepsis Campaign 2026

The Surviving Sepsis Campaign published its 2026 guidelines in March 2026, replacing the 2021 edition this module was built against. 129 statements, 46 of them new. Four points change how the infusions calculated here should be titrated:
  • MAP target 65 mmHg initially, and 60 to 65 mmHg in patients aged 65 and over. This is the practical change. Targeting higher pressures across the board in vasodilatory shock is associated with increased mortality, so the older patient is titrated to a lower, not a higher, number.
  • Peripheral initiation of vasopressors is suggested rather than waiting on central access. A delay in starting noradrenaline is itself a harm.
  • Fluids: at least 30 mL/kg crystalloid within the first three hours in sepsis-induced hypoperfusion or septic shock, with frequent reassessment. The reassessment is the point; the 30 mL/kg is a starting position, not a target to be met regardless of response.
  • Active fluid removal is suggested after the acute resuscitation phase, with diuretics first and ultrafiltration if diuretics are insufficient. Judged on cardiorespiratory function, vasopressor dose, oedema, weight and cumulative balance.
Vasopressor selection in the table above is unchanged by the 2026 edition. Noradrenaline remains first line in septic shock.
Abbreviations ACE (Angiotensin-Converting Enzyme) · ACS (Acute Coronary Syndrome) · AFib (Atrial Fibrillation) · AKI (Acute Kidney Injury) · aPTT (Activated Partial Thromboplastin Time) · AV (Atrioventricular) · BP (Blood Pressure) · CKD (Chronic Kidney Disease) · COPD (Chronic Obstructive Pulmonary Disease) · DKA (Diabetic Ketoacidosis) · DVT (Deep Vein Thrombosis) · FEV1 (Forced Expiratory Volume in One Second) · GI (Gastrointestinal) · HFrEF (Heart Failure with Reduced Ejection Fraction) · HHS (Hyperosmolar Hyperglycaemic State) · HIT (Heparin-Induced Thrombocytopenia) · ICU (Intensive Care Unit) · IV (Intravenous) · K (Potassium) · M6G (Morphine-6-Glucuronide) · MAP (Mean Arterial Pressure) · NS (Normal Saline) · NTG (Nitroglycerine) · PDE-5 (Phosphodiesterase-5) · PE (Pulmonary Embolism) · PPI (Proton Pump Inhibitor) · PVC (Polyvinyl Chloride) · RSI (Rapid Sequence Intubation) · SBAR (Situation, Background, Assessment, Recommendation) · SVR (Systemic Vascular Resistance) · TOF (Train of Four) · TXA (Tranexamic Acid) · 5%D (5% Dextrose)
References
  1. Prescott HC, Antonelli M, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026. Intensive Care Med. 2026;52(5):863-936. PMID 41870560.
  2. Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Intensive Care Med. 2021;47(11):1181-1247. PMID 34599691. [Superseded by the 2026 edition above; kept because several rates on this page date from it]
  3. Raschke RA, Reilly BM, Guidry JR, Fontana JR, Srinivas S. The weight-based heparin dosing nomogram compared with a "standard care" nomogram. A randomized controlled trial. Ann Intern Med. 1993;119(9):874-881. PMID 8214998.
  4. De Backer D, Biston P, Devriendt J, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010;362(9):779-789. PMID 20200382.
  5. Russell JA, Walley KR, Singer J, et al. Vasopressin versus norepinephrine infusion in patients with septic shock (VASST). N Engl J Med. 2008;358(9):877-887. PMID 18305265.
  6. Devlin JW, Skrobik Y, Gelinas C, et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU (PADIS). Crit Care Med. 2018;46(9):e825-e873. PMID 30113379.
  7. The Magpie Trial Collaborative Group. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Lancet. 2002;359(9321):1877-1890. PMID 12057549.
  8. CRASH-2 trial collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376(9734):23-32. PMID 20554319.
  9. Divatia JV, Amin PR, Ramakrishnan N, et al. Intensive Care in India: The Indian Intensive Care Case Mix and Practice Patterns Study. Indian J Crit Care Med. 2016;20(4):216-225. PMID 27186054.

Three entries were replaced on 28 August 2026 because they could not be traced as written. "Indian Society of Critical Care Medicine (ISCCM). Standard Treatment Guidelines for Hemodynamic Support in Sepsis" carried no year and no publication; "Tariq SM, et al. Vasopressor and Inotrope Use in Indian ICUs: A Practice Pattern Survey. Indian J Crit Care Med" carried no year, no volume and no pages, and no paper of that title or by that author on that subject could be found in PubMed on 28 August 2026; and "Advanced Cardiac Life Support (ACLS) Guidelines, American Heart Association (AHA) Updates" named no edition. The 2026 campaign guideline entry also carried the claim "129 statements, 46 new", which could not be verified and has been removed. Every entry above was opened on the date shown.

How to Cite This Tool

DOIhttps://doi.org/10.5281/zenodo.22401604

AMA Style:Umakanth S. ICU Infusions and Inotropes. Version 1.9. MEDiscuss Clinical Decision Support System. Published 2026. Accessed . https://mediscuss.org/cdss/icu-infusion-dosing. doi:10.5281/zenodo.22401604

Vancouver Style:Umakanth S. ICU Infusions and Inotropes [Internet]. Version 1.9. MEDiscuss.org; 2026 [cited ]. Available from: https://mediscuss.org/cdss/icu-infusion-dosing. doi:10.5281/zenodo.22401604

Disclaimer and scope
Disclaimer: This decision-support system is written for healthcare professionals. It does not substitute clinical judgment, and the treating physician retains absolute responsibility for every diagnostic, dosing and therapeutic decision. The algorithms are built on the evidence as it stands, and the evidence moves. Verify the output against your current institutional protocol, and against the patient in front of you.
© 2026 MEDiscuss.org. All rights reserved. Provided free of charge for clinical use. Unauthorised reproduction or redistribution is strictly prohibited.
Category Acute ResuscitationCalculator
Specialties Internal Medicine, Critical Care
Status Essential

Written and maintained by

Dr Shashikiran Umakanth

Last revised 24 August 2026

How these tools are written and reviewed

Related Clinical Tools
Sepsis & ICU ScoringBMI, BSA & Dosing WeightOrganophosphorus PoisoningMAP, Shock Index & Pulse Pressure
Further Reading on MEDiscuss
Emergency drug charts for ICUHow to make each infusion up at the bedside, alongside the dose range