title: Scandinavian SSAI clinical practice guideline on choice of first-line vasopressor for patients with acute circulatory failure.
abstract: BACKGROUND
  Adult critically ill patients often suffer from acute circulatory failure, necessitating use of vasopressor therapy. The aim of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) task force for Acute Circulatory Failure was to present clinically relevant, evidence-based treatment recommendations on this topic.
  
  
  METHODS
  This guideline was developed according to standards for trustworthy guidelines, including a systematic review of the literature and use of the GRADE methodology for assessment of the quality of evidence and for moving from evidence to recommendations. We assessed the following subpopulations of patients with acute circulatory failure: 1) shock in general, 2) septic shock, 3) cardiogenic shock, 4) hypovolemic shock and 5) other types of shock, including vasodilatory shock. We assessed patient-important outcome measures, including mortality, serious adverse reactions and quality-of-life.
  
  
  RESULTS
  For patients with shock in general and those with septic shock, we recommend using norepinephrine rather than dopamine, and we suggest using norepinephrine rather than epinephrine, vasopressin analogues, and phenylephrine. For patients with cardiogenic shock and those with hypovolemic shock, we suggest using norepinephrine rather than dopamine, and we provide no recommendations/suggestions of norepinephrine vs. epinephrine, vasopressin analogues, and phenylephrine. For patients with other types of shock, including vasodilatory shock, we suggest using norepinephrine rather than dopamine, epinephrine, vasopressin analogues, and phenylephrine.
  
  
  CONCLUSIONS
  We recommend using norepinephrine rather than other vasopressors as first-line treatment for the majority of adult critically ill patients with acute circulatory failure.
authors: Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark. mortenhylander@gmail.com.
authors: M H
authors: http://orcid.org/0000-0002-6378-9673
authors: MH
authors: Møller
authors: Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark.
authors: C
authors: C
authors: Claudius
authors: Department of Anaesthesiology, Tampere University Hospital, Tampere, Finland.
authors: E
authors: E
authors: Junttila
authors: Anaesthesiology and Intensive Care Medicine, Umeå University, Umeå, Sweden.
authors: M
authors: http://orcid.org/0000-0002-4049-8910
authors: M
authors: Haney
authors: Department of Anaesthesiology and Intensive Care, Department of Medicine and Health, Linköping University, Linköping, Sweden.
authors: A
authors: A
authors: Oscarsson-Tibblin
authors: Department of Anaesthesiology and Intensive Care, University Hospital Northern Norway, Tromsø, Norway.
authors: A
authors: A
authors: Haavind
authors: Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark.
authors: A
authors: A
authors: Perner
mesh_terms: D000208:Acute Disease; D006801:Humans; D009638:Norepinephrine / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D012769:Shock / Q000188:drug therapy*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D009638:Norepinephrine