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Current use of inotropes in circulatory shock
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...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846624/ https://www.ncbi.nlm.nih.gov/pubmed/33512597 http://dx.doi.org/10.1186/s13613-021-00806-8 |
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author | Scheeren, Thomas W. L. Bakker, Jan Kaufmann, Thomas Annane, Djillali Asfar, Pierre Boerma, E. Christiaan Cecconi, Maurizio Chew, Michelle S. Cholley, Bernard Cronhjort, Maria De Backer, Daniel Dubin, Arnaldo Dünser, Martin W. Duranteau, Jacques Gordon, Anthony C. Hajjar, Ludhmila A. Hamzaoui, Olfa Hernandez, Glenn Kanoore Edul, Vanina Koster, Geert Landoni, Giovanni Leone, Marc Levy, Bruno Martin, Claude Mebazaa, Alexandre Monnet, Xavier Morelli, Andrea Payen, Didier Pearse, Rupert M. Pinsky, Michael R. Radermacher, Peter Reuter, Daniel A. Sakr, Yasser Sander, Michael Saugel, Bernd Singer, Mervyn Squara, Pierre Vieillard-Baron, Antoine Vignon, Philippe Vincent, Jean-Louis van der Horst, Iwan C. C. Vistisen, Simon T. Teboul, Jean-Louis |
author_facet | Scheeren, Thomas W. L. Bakker, Jan Kaufmann, Thomas Annane, Djillali Asfar, Pierre Boerma, E. Christiaan Cecconi, Maurizio Chew, Michelle S. Cholley, Bernard Cronhjort, Maria De Backer, Daniel Dubin, Arnaldo Dünser, Martin W. Duranteau, Jacques Gordon, Anthony C. Hajjar, Ludhmila A. Hamzaoui, Olfa Hernandez, Glenn Kanoore Edul, Vanina Koster, Geert Landoni, Giovanni Leone, Marc Levy, Bruno Martin, Claude Mebazaa, Alexandre Monnet, Xavier Morelli, Andrea Payen, Didier Pearse, Rupert M. Pinsky, Michael R. Radermacher, Peter Reuter, Daniel A. Sakr, Yasser Sander, Michael Saugel, Bernd Singer, Mervyn Squara, Pierre Vieillard-Baron, Antoine Vignon, Philippe Vincent, Jean-Louis van der Horst, Iwan C. C. Vistisen, Simon T. Teboul, Jean-Louis |
author_sort | Scheeren, Thomas W. L. |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-7846624 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-78466242021-02-04 Current use of inotropes in circulatory shock Scheeren, Thomas W. L. Bakker, Jan Kaufmann, Thomas Annane, Djillali Asfar, Pierre Boerma, E. Christiaan Cecconi, Maurizio Chew, Michelle S. Cholley, Bernard Cronhjort, Maria De Backer, Daniel Dubin, Arnaldo Dünser, Martin W. Duranteau, Jacques Gordon, Anthony C. Hajjar, Ludhmila A. Hamzaoui, Olfa Hernandez, Glenn Kanoore Edul, Vanina Koster, Geert Landoni, Giovanni Leone, Marc Levy, Bruno Martin, Claude Mebazaa, Alexandre Monnet, Xavier Morelli, Andrea Payen, Didier Pearse, Rupert M. Pinsky, Michael R. Radermacher, Peter Reuter, Daniel A. Sakr, Yasser Sander, Michael Saugel, Bernd Singer, Mervyn Squara, Pierre Vieillard-Baron, Antoine Vignon, Philippe Vincent, Jean-Louis van der Horst, Iwan C. C. Vistisen, Simon T. Teboul, Jean-Louis Ann Intensive Care Research 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. Springer International Publishing 2021-01-29 /pmc/articles/PMC7846624/ /pubmed/33512597 http://dx.doi.org/10.1186/s13613-021-00806-8 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Research Scheeren, Thomas W. L. Bakker, Jan Kaufmann, Thomas Annane, Djillali Asfar, Pierre Boerma, E. Christiaan Cecconi, Maurizio Chew, Michelle S. Cholley, Bernard Cronhjort, Maria De Backer, Daniel Dubin, Arnaldo Dünser, Martin W. Duranteau, Jacques Gordon, Anthony C. Hajjar, Ludhmila A. Hamzaoui, Olfa Hernandez, Glenn Kanoore Edul, Vanina Koster, Geert Landoni, Giovanni Leone, Marc Levy, Bruno Martin, Claude Mebazaa, Alexandre Monnet, Xavier Morelli, Andrea Payen, Didier Pearse, Rupert M. Pinsky, Michael R. Radermacher, Peter Reuter, Daniel A. Sakr, Yasser Sander, Michael Saugel, Bernd Singer, Mervyn Squara, Pierre Vieillard-Baron, Antoine Vignon, Philippe Vincent, Jean-Louis van der Horst, Iwan C. C. Vistisen, Simon T. Teboul, Jean-Louis Current use of inotropes in circulatory shock |
title | Current use of inotropes in circulatory shock |
title_full | Current use of inotropes in circulatory shock |
title_fullStr | Current use of inotropes in circulatory shock |
title_full_unstemmed | Current use of inotropes in circulatory shock |
title_short | Current use of inotropes in circulatory shock |
title_sort | current use of inotropes in circulatory shock |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846624/ https://www.ncbi.nlm.nih.gov/pubmed/33512597 http://dx.doi.org/10.1186/s13613-021-00806-8 |
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