Consensus on use of inotrope in critically ill patients
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.
- 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
- Low cardiac output is a trigger for inotropic treatment
- Signs of hypoperfusion are a trigger for inotropic treatment
- 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.