ArticleAnnals of intensive care2021
Current use of inotropes in circulatory shock.
Article in Annals of intensive care, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
30 citing papers in PubMed, 2 syntheses or guidelines pooled it, 64 citations in OpenAlex.
- The quantitative haemodynamic effect of levosimendan, dobutamine, and milrinone in heart failure patients: a meta-analysis.ESC heart failure · 2026Pooled it
- Inotropes, vasopressors, and mechanical circulatory support for treatment of cardiogenic shock complicating myocardial infarction: a systematic review and network meta-analysis.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2022Pooled it
- Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026.Intensive care medicine · 2026Article
- Contemporary evidence to inform management of deceased potential thoracic organ donors after brain death.JHLT open · 2026Article
- Experts' recommendations for the management of adult patients with cardiogenic shock.Annals of intensive care · 2026Article
- Dobutamine administration: a proposal for a standardized approach.Intensive care medicine experimental · 2025Article
- Article
- Validation of SCAI Shock Staging in Critically Ill Medical Intensive Care Unit Patients With Sepsis and Septic Shock.Journal of community hospital internal medicine perspectives · 2025Article
- Identifying essential medications for critical care: initial findings from US academic intensive care units.Journal of pharmaceutical policy and practice · 2025Article
- Current Emergency Medical Service Vasoactive Use for the Management of Shock.Critical care explorations · 2024Article
- Management of cardiogenic shock: state-of-the-art.Intensive care medicine · 2024Review
- Inotropic Agents: Are We Still in the Middle of Nowhere?Journal of clinical medicine · 2024Review
- Levosimendan and Dobutamin Attenuate LPS-Induced Inflammation in Microglia by Inhibiting the NF-κB Pathway and NLRP3 Inflammasome Activation via Nrf2/HO-1 Signalling.Biomedicines · 2024Article
- Percutaneous Mechanical Circulatory Support in Acute Heart Failure Complicated with Cardiogenic Shock.Journal of clinical medicine · 2024Review
- The Effects of Dobutamine in Septic Shock: An Updated Narrative Review of Clinical and Experimental Studies.Medicina (Kaunas, Lithuania) · 2024Review
- Cardiac arrest, stony heart, and cardiopulmonary resuscitation: An updated revisit.World journal of cardiology · 2024Review
- From medical therapy to mechanical support: strategies for device selection and implantation techniques.European heart journal supplements : journal of the European Society of Cardiology · 2023Article
- Cardiac Syndromes in Liver Disease: A Clinical Conundrum.Journal of clinical and translational hepatology · 2023Review
- Patient-, Clinician-, and Institution-level Variation in Inotrope Use for Cardiac Surgery: A Multicenter Observational Analysis.Anesthesiology · 2023Observational
- Inflammatory mechanisms and intervention strategies for sepsis-induced myocardial dysfunction.Immunity, inflammation and disease · 2023Review
Corrections and comments
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Authors and funding
43 authors at 20 institutions in 14 countries.
Funding
Abstract
backgroundTreatment 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.
methodsFrom 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.
resultsA 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).
conclusionInotrope 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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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.