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Minerva Anestesiologica 2021 June;87(6):714-32

DOI: 10.23736/S0375-9393.20.14866-1

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Good clinical practice for the use of vasopressor and inotropic drugs in critically ill patients: state-of-the-art and expert consensus

Andrea CARSETTI ^{1, 2} ✉, Elena BIGNAMI ³, Andrea CORTEGIANI ⁴, Katia DONADELLO ⁵, Abele DONATI ^{1, 2}, Giuseppe FOTI ⁶, Giacomo GRASSELLI ^{7, 8}, Stefano ROMAGNOLI ⁹, Massimo ANTONELLI ^{10, 11}, Elvio DE BLASIO ¹², Francesco FORFORI ¹³, Fabio GUARRACINO ¹⁴, Sabino SCOLLETTA ¹⁵, Luigi TRITAPEPE ¹⁶, Luigia SCUDELLER ¹⁷, Maurizio CECCONI ¹⁸, Massimo GIRARDIS ¹⁹

¹ Anesthesia and Intensive Care Unit, Ospedali Riuniti University Hospital, Ancona, Italy; ² Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy; ³ Division of Anesthesiology, Critical Care and Pain Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy; ⁴ Department of Surgical, Oncological and Oral Science, Section of Anesthesia, Analgesia, Intensive Care and Emergency, Paolo Giaccone Polyclinic Hospital, University of Palermo, Palermo, Italy; ⁵ Anesthesia and Intensive Care B Unit, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy; ⁶ Department of Anesthesia and Intensive Care, ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; ⁷ Department of Anesthesiology, Critical Care and Emergency, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; ⁸ Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; ⁹ Section of Anesthesiology and Intensive Care, Department of Health Science, University of Florence, Careggi University Hospital, Florence, Italy; ¹⁰ Department of Anesthesiology Emergency and Intensive Care Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy; ¹¹ Università Cattolica del Sacro Cuore, Rome, Italy; ¹² Intensive Care Unit, Rummo Hospital, Benevento, Italy; ¹³ Department of Anesthesia and Intensive Care, University of Pisa, Pisa Italy; ¹⁴ Department of Anesthesia and Critical Care Medicine, Pisana University Hospital, Pisa, Italy; ¹⁵ Anesthesia and Intensive Care Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy; ¹⁶ Anesthesia and Intensive Care Unit, San Camillo-Forlanini Hospital, Rome, Italy; ¹⁷ Scientific Direction, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; ¹⁸ Department of Anesthesia and Intensive Care Units, Humanitas Clinical and Research Hospital, IRCCS, Rozzano, Milan, Italy and Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy; ¹⁹ Department of Anesthesia and Intensive Care, Modena University Hospital, Modena, Italy

Vasopressors and inotropic agents are widely used in critical care. However, strong evidence supporting their use in critically ill patients is lacking in many clinical scenarios. Thus, the Italian Society of Anesthesia and Intensive Care (SIAARTI) promoted a project aimed to provide indications for good clinical practice on the use of vasopressors and inotropes, and on the management of critically ill patients with shock. A panel of 16 experts in the field of intensive care medicine and hemodynamics has been established. Systematic review of the available literature was performed based on PICO questions. Basing on available evidence, the panel prepared a summary of evidence and then wrote the clinical questions. A modified semi-quantitative RAND/UCLA appropriateness method has been used to determine the appropriateness of specific clinical scenarios. The panel identified 29 clinical questions for the use of vasopressors and inotropes in patients with septic shock and cardiogenic shock. High level of agreement exists among the panel members about appropriateness of inotropes/vasopressors’ use in patients with septic shock and cardiogenic shock.

KEY WORDS: Septic shock; Cardiogenic shock; Cardiotonic agents; Vasoconstrictor agents