Precision in the preparation and delivery of critical care drugs is non-negotiable in the intensive care unit. Errors in dilution or infusion rate for vasoactive and sedative agents carry immediate consequences for patient safety. To eliminate ambiguity, we maintain a quick-reference chart, suitable for downloading, printing, and displaying on the ICU notice board.
The chart covers the following essential drugs: noradrenaline (norepinephrine), adrenaline (epinephrine), levosimendan, dobutamine, vasopressin, dopamine, amiodarone, midazolam, vecuronium, nitroglycerine, enalaprilat, and pantoprazole. For each agent, it specifies infusate preparation, dilution, and rate of infusion. This chart has been in continuous use in our ICU for over five years, with periodic updates to reflect current practice, and remains a valuable resource for physicians, residents, and nursing staff alike.
We strongly recommend the use of electronic syringe pumps for all infusions, as these deliver doses with far greater accuracy and allow easy titration compared with manual regulation.
CDSS for precise calculations
While this printed chart remains a useful bedside aid, our CDSS-based infusion dosing tool has now largely superseded it in clinical use. The tool computes drug concentrations and infusion rates dynamically based on patient weight and desired dose, reducing the calculation burden and the potential for manual error.
A clinical decision support tool for calculating ICU infusion drug concentrations and rates, covering vasoactive, sedative, and other critical care agents.
The CDSS toll has dose calculations for 26 ICU drugs:
Vasopressors & Inotropes (7)
1. Noradrenaline (Single Strength)
2. Noradrenaline (Double Strength)
3. Adrenaline
4. Dopamine
5. Dobutamine
6. Vasopressin
7. Levosimendan
Cardiovascular & Antiarrhythmics (7)
8. Sodium Nitroprusside
9. Esmolol
10. Nitroglycerine (NTG)
11. Diltiazem
12. Amiodarone
13. Enalaprilat
14. Labetalol
Sedation & Analgesia (5)
15. Fentanyl
16. Morphine
17. Midazolam
18. Dexmedetomidine
19. Etomidate
Paralytics (2)
20. Vecuronium
21. Atracurium
Electrolytes, Diuretics & Endocrine (5)
22. Insulin (Human Regular)
23. Furosemide (Lasix)
24. Magnesium Sulphate (Eclampsia / Pre-eclampsia)
25. Magnesium Sulphate (Severe Asthma)
26. Magnesium Sulphate (Hypomagnesaemia)
Gastrointestinal & Haematology (4)
27. Heparin (Unfractionated)
28. Pantoprazole
29. Tranexamic Acid (TXA)
30. Octreotide
For quick, real-time calculations at the bedside, the CDSS tool is now the faster and more reliable option; the printed chart still has value as an offline backup and for orientation of new staff.
