Consensus on use of inotrope in critically ill patients

Written By : Medha Baranwal |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2021-03-04T20:30:02+05:30 | Updated On 4 March 2021 8:34 PM IST

Delhi: A group of 42 international European Society of Intensive Care Medicine (ESICM) experts have formulated eleven strong recommendations for the use of inotrope in critically ill patients. The guideline is published in the journal Annals of Intensive Care.

Treatment decisions on critically ill patients with circulatory shock lack consensus. In an international survey, Thomas W. L. Scheeren, University of Groningen, Groningen, The Netherlands, and colleagues aimed to evaluate the indications, current practice, and therapeutic goals of inotrope therapy in the treatment of patients with circulatory shock.

For the purpose, an anonymous web-based survey on the use of cardiovascular drugs was made accessible to members of the 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.

Recommendations include:

Inotrope Indications

Inotropes are indicated in septic shock
Inotropes are indicated in cardiogenic shock
Inotropes are NOT indicated in hypovolemic shock

Choice of Inotrope

Dobutamine is the first-line inotrope
Dopamine is NOT a recommended inotrope

Triggers

Low cardiac output is a trigger for inotropic treatment
Signs of hypoperfusion are a trigger for inotropic treatment

Targets

Low cardiac output is a target for inotropic treatment
Signs of hypoperfusion are a target for inotropic treatment

Dosing should be lowered or stopped when

Patients experience unacceptable side effects
Patients show clinical improvement

"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," concluded the authors.

"Current use of inotropes in circulatory shock," is published in the journal Annals of Intensive Care.

DOI: https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-021-00806-8

Annals of Intensive Carecirculatory shockcritically illinotrope

Source : Annals of Intensive Care

Medha Baranwal

MSc. Biotechnology

Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. She can be contacted at editorial@medicaldialogues.in. Contact no. 011-43720751

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751