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Article Dans Une Revue Annals of Intensive Care Année : 2021

Current use of inotropes in circulatory shock

1 University of Groningen [Groningen]
2 UMCG - University Medical Center Groningen [Groningen]
3 NYU Langone Medical Center - New York University Langone Medical Center
4 CUMC - Columbia University Medical Center
5 Erasmus MC - Erasmus University Medical Center [Rotterdam]
6 Hôpital Raymond Poincaré [AP-HP]
7 UVSQ Santé - Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil
8 CHU Angers - Centre Hospitalier Universitaire d'Angers
9 MITOVASC - MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale
10 Medical Centre Leeuwarden
11 IRCCS Milan - Istituto Clinico Humanitas [Milan]
12 Hunimed - Humanitas University [Milan]
13 LIU - Linköping University
14 HEGP - Hôpital Européen Georges Pompidou [APHP]
15 UFR Médecine UPCité - UFR Médecine [Santé] - Université Paris Cité
16 Karolinska Institutet [Stockholm]
17 CHIREC - Centre Hospitalier Interrégional Edith Cavell
18 UNLP - Universidad Nacional de la Plata [Argentine]
19 JKU - University of Linz - Johannes Kepler Universität Linz
20 Kepler University Hospital
21 Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
22 Imperial College London
23 USP - Universidade de São Paulo = University of São Paulo
24 AP-HP - Hôpital Antoine Béclère [Clamart]
25 UC - Pontificia Universidad Católica de Chile
26 Hospital Juan A. Fernandez [Buenos Aires, Argentina]
27 UniSR - Universita Vita Salute San Raffaele = Vita-Salute San Raffaele University [Milan, Italie]
28 Hôpital Nord [CHU - APHM]
29 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
30 Département d’Anesthésie-Réanimation-SMUR [Hôpital Lariboisière]
31 Centre de Référence de l’Hypertension Pulmonaire Sévère [CHU Le Kremlin Bicêtre]
32 HPPIT - Hypertension pulmonaire : physiopathologie et innovation thérapeutique
33 EMily (UMR_S_1160 / U1160) - Ecotaxie, microenvironnement et développement lymphocytaire
34 Hôpital Lariboisière-Fernand-Widal [APHP]
35 William Harvey Research Institute, Barts and the London Medical School
36 QMUL - Queen Mary University of London
37 UPMC - University of Pittsburgh Medical Center [Pittsburgh, PA, États-Unis]
38 Universitätsklinikum Ulm - University Hospital of Ulm
39 University Medical Center Rostock
40 Jena University Hospital [Jena]
41 JLU - Justus-Liebig-Universität Gießen = Justus Liebig University
42 UKE - Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg]
43 UCL - University College of London [London]
44 Clinique Ambroise Paré [Centres Médico-Chirurgicaux Ambroise Pré, Pierre Cherest, Hartmann]
45 CESP - Centre de recherche en épidémiologie et santé des populations
46 CIC1435 - Centre d'Investigation Clinique de Limoges
47 ULB - Université libre de Bruxelles
48 MUMC - Maastricht University Medical Centre
49 Aarhus University Hospital
Anthony Gordon
Marc Leone
Simon Tilma Vistisen

Résumé

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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hal-03487819 , version 1 (02-06-2022)

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Thomas W.L. Scheeren, Jan Bakker, Thomas Kaufmann, Djillali Annane, Pierre Asfar, et al.. Current use of inotropes in circulatory shock. Annals of Intensive Care, 2021, 11 (1), pp.21. ⟨10.1186/s13613-021-00806-8⟩. ⟨hal-03487819⟩
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