Current use of inotropes in circulatory shock

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DOI

  • Thomas W.L. Scheeren, University of Groningen
  • ,
  • Jan Bakker, New York University, Columbia University, Erasmus University Rotterdam, Pontificia Universidad Catolica de Chile
  • ,
  • Thomas Kaufmann, University of Groningen
  • ,
  • Djillali Annane, Universite Paris-Saclay
  • ,
  • Pierre Asfar, Universite d'Angers
  • ,
  • E. Christiaan Boerma, Medical Centre Leeuwarden
  • ,
  • Maurizio Cecconi, IRCCS Istituto Clinico Humanitas - Rozzano (Milano), Humanitas University
  • ,
  • Michelle S. Chew, Linköping University
  • ,
  • Bernard Cholley, Hopital Europeen Georges-Pompidou, Université de Paris
  • ,
  • Maria Cronhjort, Karolinska Institutet
  • ,
  • Daniel De Backer, Université Libre de Bruxelles
  • ,
  • Arnaldo Dubin, Universidad Nacional de La Plata
  • ,
  • Martin W. Dünser, Johannes Kepler University
  • ,
  • Jacques Duranteau, Universite Paris-Saclay
  • ,
  • Anthony C. Gordon, Imperial College London
  • ,
  • Ludhmila A. Hajjar, Universidade de Sao Paulo
  • ,
  • Olfa Hamzaoui, Universite Paris-Saclay
  • ,
  • Glenn Hernandez, Pontificia Universidad Catolica de Chile
  • ,
  • Vanina Kanoore Edul, Hospital General de Agudos Juan Fernandez
  • ,
  • Geert Koster, University of Groningen
  • ,
  • Giovanni Landoni, Vita-Salute San Raffaele University
  • ,
  • Marc Leone, Aix-Marseille Université
  • ,
  • Bruno Levy, Universite de Lorraine
  • ,
  • Claude Martin, Aix-Marseille Université
  • ,
  • Alexandre Mebazaa, AP-HP Assistance Publique - Hopitaux de Paris
  • ,
  • Xavier Monnet, Universite Paris-Saclay, Universite Paris-Sud
  • ,
  • Andrea Morelli, University of Rome La Sapienza
  • ,
  • Didier Payen, Université de Paris
  • ,
  • Rupert M. Pearse, Queen Mary University of London
  • ,
  • Michael R. Pinsky, University of Pittsburgh
  • ,
  • Peter Radermacher, Ulm University
  • ,
  • Daniel A. Reuter, University of Rostock
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  • Yasser Sakr, Uniklinikum Jena
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  • Michael Sander, Universitätsklinikum Giessen und Marburg, Standort Giessen
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  • Bernd Saugel, University of Hamburg
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  • Mervyn Singer, University College London
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  • Pierre Squara, Clinique Ambroise Paré
  • ,
  • Antoine Vieillard-Baron, Hopital Ambroise Pare, Boulogne-Billancourt, Universite Paris-Saclay
  • ,
  • Philippe Vignon, CHU de Limoges, Universite de Limoges
  • ,
  • Jean Louis Vincent, Université Libre de Bruxelles
  • ,
  • Iwan C.C. van der Horst, Maastricht University
  • ,
  • Simon T. Vistisen
  • Jean Louis Teboul, Universite Paris-Saclay, Universite Paris-Sud

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.

OriginalsprogEngelsk
Artikelnummer21
TidsskriftAnnals of Intensive Care
Vol/bind11
ISSN2110-5820
DOI
StatusUdgivet - dec. 2021

Bibliografisk note

Funding Information:
This work has received the endorsement of the European Society of Intensive Care Medicine. The authors would like to thank Hannah Wunsch and Anders Perner, who provided their expertise as experts but abstained from being listed as co-author of this paper.

Publisher Copyright:
© 2021, The Author(s).

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

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