TY - JOUR
T1 - Current use of inotropes in circulatory shock
AU - Scheeren, Thomas W. L.
AU - Bakker, Jan
AU - Kaufmann, Thomas
AU - Annane, Djillali
AU - Asfar, Pierre
AU - Boerma, E. Christiaan
AU - Cecconi, Maurizio
AU - Chew, Michelle S.
AU - Cholley, Bernard
AU - Cronhjort, Maria
AU - De Backer, Daniel
AU - Dubin, Arnaldo
AU - Duenser, Martin W.
AU - Duranteau, Jacques
AU - Gordon, Anthony C.
AU - Hajjar, Ludhmila A.
AU - Hamzaoui, Olfa
AU - Hernandez, Glenn
AU - Kanoore Edul, Vanina
AU - Koster, Geert
AU - Landoni, Giovanni
AU - Leone, Marc
AU - Levy, Bruno
AU - Martin, Claude
AU - Mebazaa, Alexandre
AU - Monnet, Xavier
AU - Morelli, Andrea
AU - Payen, Didier
AU - Pearse, Rupert M.
AU - Pinsky, Michael R.
AU - Radermacher, Peter
AU - Reuter, Daniel A.
AU - Sakr, Yasser
AU - Sander, Michael
AU - Saugel, Bernd
AU - Singer, Mervyn
AU - Squara, Pierre
AU - Vieillard-Baron, Antoine
AU - Vignon, Philippe
AU - Vincent, Jean-Louis
AU - van der Horst, Iwan C. C.
AU - Vistisen, Simon T.
AU - Teboul, Jean-Louis
PY - 2021/1/29
Y1 - 2021/1/29
N2 - Background: Treatment decisions on critically ill patients with circulatory shock lack consensus. In an international survey, we aimed to evaluate the indications, current practice, and therapeutic goals of inotrope therapy in the treatment of patients with circulatory shock.Methods: From November 2016 to April 2017, an anonymous web-based survey on the use of cardiovascular drugs was accessible to members of the European Society of Intensive Care Medicine (ESICM). A total of 14 questions focused on the profile of respondents, the triggering factors, first-line choice, dosing, timing, targets, additional treatment strategy, and suggested effect of inotropes. In addition, a group of 42 international ESICM experts was asked to formulate recommendations for the use of inotropes based on 11 questions.Results: A total of 839 physicians from 82 countries responded. Dobutamine was the first-line inotrope in critically ill patients with acute heart failure for 84% of respondents. Two-thirds of respondents (66%) stated to use inotropes when there were persistent clinical signs of hypoperfusion or persistent hyperlactatemia despite a supposed adequate use of fluids and vasopressors, with (44%) or without (22%) the context of low left ventricular ejection fraction. Nearly half (44%) of respondents stated an adequate cardiac output as target for inotropic treatment. The experts agreed on 11 strong recommendations, all of which were based on excellent (> 90%) or good (81-90%) agreement. Recommendations include the indications for inotropes (septic and cardiogenic shock), the choice of drugs (dobutamine, not dopamine), the triggers (low cardiac output and clinical signs of hypoperfusion) and targets (adequate cardiac output) and stopping criteria (adverse effects and clinical improvement).Conclusion: Inotrope use in critically ill patients is quite heterogeneous as self-reported by individual caregivers. Eleven strong recommendations on the indications, choice, triggers and targets for the use of inotropes are given by international experts. Future studies should focus on consistent indications for inotrope use and implementation into a guideline for circulatory shock that encompasses individualized targets and outcomes.
AB - Background: Treatment decisions on critically ill patients with circulatory shock lack consensus. In an international survey, we aimed to evaluate the indications, current practice, and therapeutic goals of inotrope therapy in the treatment of patients with circulatory shock.Methods: From November 2016 to April 2017, an anonymous web-based survey on the use of cardiovascular drugs was accessible to members of the European Society of Intensive Care Medicine (ESICM). A total of 14 questions focused on the profile of respondents, the triggering factors, first-line choice, dosing, timing, targets, additional treatment strategy, and suggested effect of inotropes. In addition, a group of 42 international ESICM experts was asked to formulate recommendations for the use of inotropes based on 11 questions.Results: A total of 839 physicians from 82 countries responded. Dobutamine was the first-line inotrope in critically ill patients with acute heart failure for 84% of respondents. Two-thirds of respondents (66%) stated to use inotropes when there were persistent clinical signs of hypoperfusion or persistent hyperlactatemia despite a supposed adequate use of fluids and vasopressors, with (44%) or without (22%) the context of low left ventricular ejection fraction. Nearly half (44%) of respondents stated an adequate cardiac output as target for inotropic treatment. The experts agreed on 11 strong recommendations, all of which were based on excellent (> 90%) or good (81-90%) agreement. Recommendations include the indications for inotropes (septic and cardiogenic shock), the choice of drugs (dobutamine, not dopamine), the triggers (low cardiac output and clinical signs of hypoperfusion) and targets (adequate cardiac output) and stopping criteria (adverse effects and clinical improvement).Conclusion: Inotrope use in critically ill patients is quite heterogeneous as self-reported by individual caregivers. Eleven strong recommendations on the indications, choice, triggers and targets for the use of inotropes are given by international experts. Future studies should focus on consistent indications for inotrope use and implementation into a guideline for circulatory shock that encompasses individualized targets and outcomes.
KW - Acute circulatory failure
KW - Sepsis
KW - Septic shock
KW - Cardiogenic shock
KW - Resuscitation
KW - Inotropes
KW - Vasoactive agents
KW - Catecholamines
KW - Levosimendan
KW - PDE-inhibitors
KW - Cardiac output
U2 - 10.1186/s13613-021-00806-8
DO - 10.1186/s13613-021-00806-8
M3 - Article
C2 - 33512597
SN - 2110-5820
VL - 11
JO - Annals of Intensive Care
JF - Annals of Intensive Care
IS - 1
M1 - 21
ER -