Annals of Intensive Care (Jan 2021)
Current use of inotropes in circulatory shock
- Thomas W. L. Scheeren,
- Jan Bakker,
- Thomas Kaufmann,
- Djillali Annane,
- Pierre Asfar,
- E. Christiaan Boerma,
- Maurizio Cecconi,
- Michelle S. Chew,
- Bernard Cholley,
- Maria Cronhjort,
- Daniel De Backer,
- Arnaldo Dubin,
- Martin W. Dünser,
- Jacques Duranteau,
- Anthony C. Gordon,
- Ludhmila A. Hajjar,
- Olfa Hamzaoui,
- Glenn Hernandez,
- Vanina Kanoore Edul,
- Geert Koster,
- Giovanni Landoni,
- Marc Leone,
- Bruno Levy,
- Claude Martin,
- Alexandre Mebazaa,
- Xavier Monnet,
- Andrea Morelli,
- Didier Payen,
- Rupert M. Pearse,
- Michael R. Pinsky,
- Peter Radermacher,
- Daniel A. Reuter,
- Yasser Sakr,
- Michael Sander,
- Bernd Saugel,
- Mervyn Singer,
- Pierre Squara,
- Antoine Vieillard-Baron,
- Philippe Vignon,
- Jean-Louis Vincent,
- Iwan C. C. van der Horst,
- Simon T. Vistisen,
- Jean-Louis Teboul
Affiliations
- Thomas W. L. Scheeren
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen
- Jan Bakker
- New York University Medical Center
- Thomas Kaufmann
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen
- Djillali Annane
- School of Medicine Simone Veil, Raymond Poincaré Hospital (APHP), Department of Intensive Care Medicine, University of Versailles- University Paris Saclay
- Pierre Asfar
- Département de Médecine Intensive-Réanimation Et de Médecine Hyperbare, Centre Hospitalier Universitaire Angers; and Institut MITOVASC, CNRS UMR 6215, INSERM U1083, Angers University
- E. Christiaan Boerma
- Medical Centre Leeuwarden, Department of Intensive Care
- Maurizio Cecconi
- Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital
- Michelle S. Chew
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University
- Bernard Cholley
- Department of Anaesthesiology & Intensive Care Medicine, AP-HP, Hôpital Européen Georges Pompidou
- Maria Cronhjort
- Section of Anaesthesiology and Intensive Care, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset
- Daniel De Backer
- Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles
- Arnaldo Dubin
- Cátedra de Farmacología Aplicada, Facultad de Ciencias Médicas, Universidad Nacional de La Plata Y Servicio de Terapia Intensiva
- Martin W. Dünser
- Department of Anesthesiology and Intensive Care Medicine, Kepler University Hospital and Johannes Kepler University Linz
- Jacques Duranteau
- Department of Anaesthesia and Intensive Care, Assistance Publique Des Hopitaux de Paris, Hôpitaux Universitaires Paris-Saclay, Université Paris-Saclay, Hôpital de Bicêtre
- Anthony C. Gordon
- Division of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London
- Ludhmila A. Hajjar
- Department of Cardiopneumology, Instituto Do Coracao, Universidade de São Paulo, Hospital SirioLibanes
- Olfa Hamzaoui
- Assistance Publique-Hôpitaux de Paris, Paris Saclay University Hospitals, Antoine Béclère Hospital
- Glenn Hernandez
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile
- Vanina Kanoore Edul
- Servicio de Terapia Intensiva, Hospital Fernández
- Geert Koster
- Department of Critical Care, University of Groningen, University Medical Center Groningen
- Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University
- Marc Leone
- Aix Marseille Université, Assistance Publique Hôpitaux de Marseille, Service D’Anesthésie Et de Réanimation CHU Nord
- Bruno Levy
- Service de Réanimation Médicale Brabois Et Pôle Cardio-Médico-Chirurgical. CHRU Brabois, INSERM U1116, Université de Lorraine
- Claude Martin
- Aix Marseille Université, Assistance Publique Hôpitaux de Marseille, Service D’Anesthésie Et de Réanimation CHU Nord
- Alexandre Mebazaa
- Department of Anesthesia, Burn and Critical Care, APHP Hôpitaux Universitaires Saint Louis LariboisièreUniversité Paris DiderotU942 Inserm
- Xavier Monnet
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University Hospitals
- Andrea Morelli
- Department of Clinical Internal, Anesthesiological and Cardiovascular Science, Sapienza University of Rome
- Didier Payen
- University Paris 7 Denis Diderot; INSERM 1160 and Hôpital Lariboisière, APHP
- Rupert M. Pearse
- William Harvey Research Institute, Queen Mary University of London
- Michael R. Pinsky
- Department of Critical Care Medicine, University of Pittsburgh
- Peter Radermacher
- Institut Für Anästhesiologische Pathophysiologie Und Verfahrensentwicklung, Universitätsklinikum Ulm
- Daniel A. Reuter
- Department of Anesthesiology and Intensive Care Medicine, Rostock University Medical Centre
- Yasser Sakr
- Department of Anesthesiology and Intensive Care, Uniklinikum Jena
- Michael Sander
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Giessen, UKGM, Justus-Liebig University Giessen
- Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf
- Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London
- Pierre Squara
- ICU Department, Réanimation CERIC, Clinique Ambroise Paré
- Antoine Vieillard-Baron
- Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré
- Philippe Vignon
- Medical-Surgical Intensive Care Unit, INSERM CIC-1435, Teaching Hospital of Limoges
- Jean-Louis Vincent
- Université Libre de Bruxelles - Dept of Intensive Care, Erasme Univ Hospital
- Iwan C. C. van der Horst
- Department of Intensive Care Medicine, Maastricht University Medical Center
- Simon T. Vistisen
- Institute of Clinical Medicine, Aarhus University
- Jean-Louis Teboul
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University Hospitals
- DOI
- https://doi.org/10.1186/s13613-021-00806-8
- Journal volume & issue
-
Vol. 11,
no. 1
pp. 1 – 13
Abstract
Abstract 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.
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