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Minerva Anestesiologica 2021 Jan 12

DOI: 10.23736/S0375-9393.20.14866-1


language: English

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

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

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

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