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


CONCLUSIONS
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.
Oldner
A
A
Department of Anaesthesiology & Intensive Care, Karolinska Hospital, Stockholm, Sweden. anders.oldner@ks.se
Rossi
P
P
Karason
S
S
Aneman
A
A
D000328:Adult; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002317:Cardiovascular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003625:Data Collection; D016208:Databases, Factual; D004363:Drug Utilization; D005260:Female; D005440:Fluid Therapy; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D020407:Internet; D008297:Male; D008991:Monitoring, Physiologic; D010952:Plasma Substitutes / Q000627:therapeutic use; D012537:Scandinavian and Nordic Countries
D002316:Cardiotonic Agents; D002317:Cardiovascular Agents; D010952:Plasma Substitutes