Scandinavian SSAI clinical practice guideline on choice of inotropic agent for patients with acute circulatory failure

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Moller , M H , Granholm , A , Junttila , E , Haney , M , Oscarsson-Tibblin , A , Haavind , A , Laake , J H , Wilkman , E , Sverrisson , K O & Perner , A 2018 , ' Scandinavian SSAI clinical practice guideline on choice of inotropic agent for patients with acute circulatory failure ' , Acta Anaesthesiologica Scandinavica , vol. 62 , no. 4 , pp. 420-450 . https://doi.org/10.1111/aas.13089

Title: Scandinavian SSAI clinical practice guideline on choice of inotropic agent for patients with acute circulatory failure
Author: Moller, M. H.; Granholm, A.; Junttila, E.; Haney, M.; Oscarsson-Tibblin, A.; Haavind, A.; Laake, J. H.; Wilkman, E.; Sverrisson, K. O.; Perner, A.
Other contributor: University of Helsinki, Department of Diagnostics and Therapeutics



Date: 2018-04
Language: eng
Number of pages: 31
Belongs to series: Acta Anaesthesiologica Scandinavica
ISSN: 0001-5172
DOI: https://doi.org/10.1111/aas.13089
URI: http://hdl.handle.net/10138/233886
Abstract: BackgroundAdult critically ill patients often suffer from acute circulatory failure and those with low cardiac output may be treated with inotropic agents. The aim of this Scandinavian Society of Anaesthesiology and Intensive Care Medicine guideline was to present patient-important treatment recommendations on this topic. MethodsThis guideline was developed according to GRADE. We assessed the following subpopulations of patients with shock: (1) shock in general, (2) septic shock, (3) cardiogenic shock, (4) hypovolemic shock, (5) shock after cardiac surgery, and (6) other types of shock, including vasodilatory shock. We assessed patient-important outcome measures, including mortality and serious adverse reactions. ResultsFor all patients, we suggest against the routine use of any inotropic agent, including dobutamine, as compared to placebo/no treatment (very low quality of evidence). For patients with shock in general, and in those with septic and other types of shock, we suggest using dobutamine rather than levosimendan or epinephrine (very low quality of evidence). For patients with cardiogenic shock and in those with shock after cardiac surgery, we suggest using dobutamine rather than milrinone (very low quality of evidence). For the other clinical questions, we refrained from giving any recommendations or suggestions. ConclusionsWe suggest against the routine use of any inotropic agent in adult patients with shock. If used, we suggest using dobutamine rather than other inotropic agents for the majority of patients, however, the quality of evidence was very low, implying high uncertainty on the balance between the benefits and harms of inotropic agents.
Subject: LOW CARDIAC-OUTPUT
DECOMPENSATED HEART-FAILURE
TRIAL SEQUENTIAL-ANALYSIS
SEPTIC SHOCK
CARDIOGENIC-SHOCK
LEVOSIMENDAN
DOBUTAMINE
SURGERY
METAANALYSIS
GRADE
3126 Surgery, anesthesiology, intensive care, radiology
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