Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Nov;60(10):1347-1366.
doi: 10.1111/aas.12780. Epub 2016 Aug 31.

Scandinavian SSAI clinical practice guideline on choice of first-line vasopressor for patients with acute circulatory failure

M H Møller  1 , C Claudius  2 , E Junttila  3 , M Haney  4 , A Oscarsson-Tibblin  5 , A Haavind  6 , A Perner  2
Affiliations

Scandinavian SSAI clinical practice guideline on choice of first-line vasopressor for patients with acute circulatory failure

M H Møller et al. Acta Anaesthesiol Scand. 2016 Nov.

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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Forest plot of (A) short‐term all‐cause mortality, (B) Ischemic events, (C) dysrhythmias, and (D) hospital length of stay in randomised trials of norepinephrine (NE) vs. other vasopressors for patients with shock in general. Size of squares for risk ratio reflects weight of trial in pooled analyses. Horizontal bars represent 95% confidence intervals.
Figure 2
Figure 2
Forest plot of (A) short‐term all‐cause mortality, (B) ischaemic events, (C) renal replacement therapy, (D) dysrhythmias, and (E) hospital length of stay in randomised trials of norepinephrine (NE) vs. other vasopressors for patients with septic shock. Size of squares for risk ratio reflects weight of trial in pooled analyses. Horizontal bars represent 95% confidence intervals.
Figure 3
Figure 3
Forest plot of (A) short‐term all‐cause mortality, (B) ischaemic events, (C) renal replacement therapy, and (D) dysrhythmias in randomised trials of norepinephrine (NE) vs. other vasopressors for patients with other types of shock, including vasodilatory shock. Size of squares for risk ratio reflects weight of trial in pooled analyses. Horizontal bars represent 95% confidence intervals.
See this image and copyright information in PMC

References

    1. Vincent JL, De Backer D. Circulatory shock. N Engl J Med 2013; 369: 1726–34. - PubMed
    1. Weil MH, Shubin H. Proposed reclassification of shock states with special reference to distributive defects. Adv Exp Med Biol 1971; 23: 13–23. - PubMed
    1. Laine C, Taichman DB, Mulrow C. Trustworthy clinical guidelines. Ann Intern Med 2011; 154: 774–5. - PubMed
    1. Qaseem A, Forland F, Macbeth F, Ollenschlager G, Phillips S, van der Wees P, Board of Trustees of the Guidelines International N . Guidelines International Network: toward international standards for clinical practice guidelines. Ann Intern Med 2012;156:525–31. - PubMed
    1. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck‐Ytter Y, Alonso‐Coello P, Schunemann HJ. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008; 336: 924–6. - PMC - PubMed

Publication types