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Current use of inot...
Current use of inotropes in circulatory shock
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- Scheeren, Thomas W. L. (author)
- Univ Groningen, Netherlands
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- Bakker, Jan (author)
- NYU, NY USA; Columbia Univ, NY USA; Erasmus MC, Netherlands; Pontificia Univ Catolica Chile, Chile
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- Kaufmann, Thomas (author)
- Univ Groningen, Netherlands
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- Annane, Djillali (author)
- Univ Paris Saclay, France
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- Asfar, Pierre (author)
- Angers Univ, France
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- Boerma, E. Christiaan (author)
- Med Ctr Leeuwarden, Netherlands
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- Cecconi, Maurizio (author)
- IRCCS Humanitas Res Hosp, Italy; Humanitas Univ, Italy
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- Chew, Michelle (author)
- Linköpings universitet,Avdelningen för klinisk kemi och farmakologi,Medicinska fakulteten,Region Östergötland, ANOPIVA US
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- Cholley, Bernard (author)
- Hop Europeen Georges Pompidou, France; Univ Paris, France
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- Cronhjort, Maria (author)
- Karolinska Institutet
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- De Backer, Daniel (author)
- Univ Libre Bruxelles, Belgium
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- Dubin, Arnaldo (author)
- Univ Nacl La Plata, Argentina; Sanatorio Otamendi, Argentina
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- Duenser, Martin W. (author)
- Kepler Univ Hosp, Austria; Johannes Kepler Univ Linz, Austria
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- Duranteau, Jacques (author)
- Univ Paris Saclay, France
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- Gordon, Anthony C. (author)
- Imperial Coll London, England
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- Hajjar, Ludhmila A. (author)
- Univ Sao Paulo, Brazil
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- Hamzaoui, Olfa (author)
- Paris Saclay Univ Hosp, France
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- Hernandez, Glenn (author)
- Pontificia Univ Catolica Chile, Chile
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- Kanoore Edul, Vanina (author)
- Hosp Fernandez, Argentina
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- Koster, Geert (author)
- Univ Groningen, Netherlands
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- Landoni, Giovanni (author)
- Univ Vita Salute San Raffaele, Italy
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- Leone, Marc (author)
- Aix Marseille Univ, France
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- Levy, Bruno (author)
- Univ Lorraine, France
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- Martin, Claude (author)
- Aix Marseille Univ, France
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- Mebazaa, Alexandre (author)
- Univ Paris Diderot, France
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- Monnet, Xavier (author)
- Paris Saclay Univ Hosp, France; FHU SEPSIS, France
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- Morelli, Andrea (author)
- Sapienza Univ Rome, Italy
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- Payen, Didier (author)
- Univ Paris 07, France; INSERM 1160, France; Hop Lariboisiere, France
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- Pearse, Rupert M. (author)
- Queen Mary Univ London, England
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- Pinsky, Michael R. (author)
- Univ Pittsburgh, PA USA
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- Radermacher, Peter (author)
- Univ Klinikum Ulm, Germany
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- Reuter, Daniel A. (author)
- Rostock Univ, Germany
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- Sakr, Yasser (author)
- Uniklinikum Jena, Germany
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- Sander, Michael (author)
- Justus Liebig Univ Giessen, Germany
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- Saugel, Bernd (author)
- Univ Med Ctr Hamburg Eppendorf, Germany
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- Singer, Mervyn (author)
- UCL, England
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- Squara, Pierre (author)
- Clin Ambroise Pare, France
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- Vieillard-Baron, Antoine (author)
- Univ Hosp Ambroise Pare, France; Univ Versailles St Quentin Yvelines, France
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- Vignon, Philippe (author)
- Teaching Hosp Limoges, France; Univ Limoges, France
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- Vincent, Jean-Louis (author)
- Univ Libre Bruxelles, Belgium
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- van der Horst, Iwan C. C. (author)
- Maastricht Univ, Netherlands
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- Vistisen, Simon T. (author)
- Aarhus Univ, Denmark; Aarhus Univ Hosp, Denmark
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- Teboul, Jean-Louis (author)
- Paris Saclay Univ Hosp, France; FHU SEPSIS, France
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(creator_code:org_t)
- 2021-01-29
- 2021
- English.
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In: Annals of Intensive Care. - : Springer. - 2110-5820. ; 11:1
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Abstract
Subject headings
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- BackgroundTreatment 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.MethodsFrom 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.ResultsA 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).ConclusionInotrope 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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)
Keyword
- Acute circulatory failure; Sepsis; Septic shock; Cardiogenic shock; Resuscitation; Inotropes; Vasoactive agents; Catecholamines; Levosimendan; PDE-inhibitors; Cardiac output
Publication and Content Type
- ref (subject category)
- art (subject category)
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Scheeren, Thomas ...
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Bakker, Jan
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Kaufmann, Thomas
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Annane, Djillali
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Asfar, Pierre
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Boerma, E. Chris ...
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Cecconi, Maurizi ...
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Chew, Michelle
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Cholley, Bernard
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Cronhjort, Maria
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De Backer, Danie ...
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Dubin, Arnaldo
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Duenser, Martin ...
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Duranteau, Jacqu ...
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Gordon, Anthony ...
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Hajjar, Ludhmila ...
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Hamzaoui, Olfa
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Hernandez, Glenn
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Kanoore Edul, Va ...
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Koster, Geert
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Landoni, Giovann ...
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Leone, Marc
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Levy, Bruno
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Martin, Claude
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Mebazaa, Alexand ...
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Monnet, Xavier
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Morelli, Andrea
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Payen, Didier
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Pearse, Rupert M ...
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Pinsky, Michael ...
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Radermacher, Pet ...
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Reuter, Daniel A ...
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Sakr, Yasser
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Sander, Michael
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Saugel, Bernd
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Singer, Mervyn
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Squara, Pierre
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Vieillard-Baron, ...
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Vignon, Philippe
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Vincent, Jean-Lo ...
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van der Horst, I ...
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Vistisen, Simon ...
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Teboul, Jean-Lou ...
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Anesthesiology a ...
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Annals of Intens ...
- By the university
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Linköping University
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Karolinska Institutet