A practice survey on vasopressor and inotropic drug therapy in Scandinavian intensive care units

Abstract

Background: This practice survey was performed to analyse the indications for use of vasopressor/inotropic drugs, preferred drugs and doses as well as concomitant monitoring and desired haemodynamic target values in Scandinavian ICUs. An internet‐based reporting system was implemented.Methods: A total of 223 ICUs were identified in the Scandinavian countries and invited to participate in a one‐day point‐prevalence study. An internet‐based database was constructed and a practice survey protocol designed to identify haemodynamic monitoring, indications for vasopressor/inotropic drug‐therapy, fluids used for volume loading, pretreatment circulatory state, actual and targeted haemodynamic variables. Patients were eligible for the study if on vasopressor/inotropic drug‐therapy for more than 4 h.Results: A total of 114 ICUs participated. A total of 114 adult patients matched the inclusion criteria. Sixty‐seven per cent of the patients had received vasopressor/inotropic drug‐treatment for >24 h and 32% received more than one drug. Arterial hypotension (92%) and oliguria (50%) were most common indications. Fluid loading prior to therapy was reported in 87% of patients. Dopamine (47%) and noradrenaline (44%) were the most commonly used drugs followed by dobutamine (24%). No other drug exceeded 6%. Non‐catecholamine drugs were rarely used even in cardiac failure patients. Invasive arterial pressure was monitored in 95% of patients, pulmonary artery catheters were used in 19%. Other cardiac output monitoring techniques were used in 8.5% of the patients.Conclusion: Dopamine and noradrenaline seem to be the most commonly used inotropic/vasopressor drugs in Scandinavia. Traditional indications for inotropic/vasopressor support as hypotension and oliguria seem to be most common. Invasive monitoring was used in almost all patients, whereas a limited use of pulmonary artery catheters was noted. The internet‐based reporting system proved to be an efficient tool for data collection.

Initial fluid resuscitation of patients with septic shock in the intensive care unit

“…Our data support two previous surveys that indicate that blood products are used for resuscitation in Scandinavian ICUs. 9,13 In the present study, the administration of RBCs, plasma and platelets was not associated with outcome. The two trials randomising septic patients to different RBC transfusion strategies have showed divergent results.…”

“…Our results are also supported by previous Scandinavian data showing preference for HES 130/0.4 for ICU patients 9 and the use of a combination of colloids, crystalloids and blood products in shock patients. 13 The composition of resuscitation fluids for sepsis is controversial. In particular, the use of colloids is a matter of debate.…”

Higher vs. lower fluid volume for septic shock: clinical characteristics and outcome in unselected patients in a prospective, multicenter cohort

“…The following interventions were recorded every day during shock: the type and volume of administered fluid, including crystalloids (isotonic NaCl, Ringer's lactate or acetate, other electrolyte solutions, or isotonic glucose); colloids (albumin, hydroxyethyl starch (HES), or dextran; gelatin was not used in the present cohort); blood products (red blood cells (RBCs), fresh frozen plasma, or platelet concentrate; blood products were included because data indicate that these are used for resuscitation in Scandinavian ICUs [9,10]); nutrition given (any nutritional product containing glucose of greater than 5%, amino acids, or lipids); use of corticosteroids, invasive ventilation, or renal replacement therapy; and type and maximum dose of infused inotrope/vasopressor drugs. Dopamine doses were converted into comparable doses of norepinephrine so that 1 μg/kg per minute dopamine equaled 0.01 μg/kg per minute norepinephrine [11].…”

Treatment for paediatric low cardiac output syndrome: results from the European EuLoCOS-Paed survey

“…Kastrup et al 16 showed that 42% of German clinicians select epinephrine from eight drug options as the first-choice drug for adult patients with LCOS, 91% of French clinicians select dobutamine from four drug options for cardiogenic shock15 and 64% of clinicians from Scandinavia select dopamine for cardiac failure 14. The present survey probably revealed higher variability in drug use because it focussed on children and hospitals from all over Europe, and also subcategorised LCOS and evaluated stepwise treatment algorithms without limiting drug choices.…”

“…Development of the EuLoCOS-Paed questionnaire was guided by previous surveys on vasoactive drug use in adult patients14–16 and guidelines on cardiac and circulatory failure in adult and paediatric care 5 6 17 18. Standard survey methods for mail and web-based surveys were also adopted to increase the overall response rate 19 20…”