Hypotension - Treatment

Treatment

The treatment for hypotension depends on its cause. Chronic hypotension rarely exists as more than a symptom. Asymptomatic hypotension in healthy people usually does not require treatment. Adding electrolytes to a diet can relieve symptoms of mild hypotension. In mild cases, where the patient is still responsive, laying the person in dorsal decubitus (lying on the back) position and lifting the legs will increase venous return, thus making more blood available to critical organs at the chest and head. The Trendelenburg position, though used historically, is no longer recommended.

The treatment of hypotensive shock always follows the first four following steps. Outcomes, in terms of mortality, are directly linked to the speed in which hypotension is corrected. In parentheses are the still debated methods for achieving, and benchmarks for evaluating, progress in correcting hypotension. A study on septic shock provided the delineation of these general principles. However, since it focuses on hypotension due to infection, it is not applicable to all forms of severe hypotension.

1. Volume resuscitation (usually with crystalloid)
2. Blood pressure support with a vasopressor (all seem to be equivalent)
3. Ensure adequate tissue perfusion (maintain SvO2 >70 with use of blood or dobutamine)
4. Address the underlying problem (i.e. antibiotic for infection, stent or CABG (coronary artery bypass graft surgery) for infarction, steroids for adrenal insufficiency, etc...)

Medium-term (and less well-demonstrated) treatments of hypotension include:

• Blood sugar control (80-150 by one study)
• Early nutrition (by mouth or by tube to prevent ileus)
• Steroid support