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= INOTROPES AND VASOPRESSOR SCORE HISTORY =

Wernovsky et al. in 1995 wrote: “The doses of inotropic, chronotropic, and afterload reducing agents at the time of the cardiac output measurements were recorded. For between-group comparisons, a total inotrope dose was calculated by adding the doses of dopamine and dobutamine in micrograms per kilogram per minute and assigning an arbitrary equivalent value of 10 μg · kg−1 · min−1 inotrope for each 0.1 μg · kg−1 · min−1 epinephrine.”(1)

http://circ.ahajournals.org/content/92/8/2226.full

In 1999, Rosenzweig EB,  modify and named  Wernovsky`s score as Inotrope Score (IS):  “dosages of dopamine+ dobutamine+epinephrine×100+milrinone×10.”(2)

In 2010 Gaies gave the credit of IS to Wernovsky  and published a variation of Rosenzweig EB`s IS formula taking out the Milrinone (dopamine μg/kg/min + dobutamine μg/kg/min +epinephrine μg/kg/min ×100). Also added the Milrinone, Vasopressin and Norepinephrine: VIS=  IS + 10 x milrinone dose (μg/kg/min)+ 10,000 X vasopressin dose (U/kg/min) +  100 x norepinephrine dose (μg/kg/min) naming this formula as Vasopressor-Inotrope Score (VIS). (3)

Since then, in 2012 Daivdson (4)validate the IS and VIS according Wernovsky and Gaie`s papers and many authors is being using these score in many papers as notice in Kumar M, 2014 ( http://www.ijccm.org/temp/IJCCM1810653-4960029_134640.pdf ); Piva j, 2014; Guerra G, 2014; Gaudard P, 2015; Sidhu N, 2015; Ventura AM, 2015.(5-10) Table 1.

Most recently Rambaud J, 2015 used the IS formula accoding the “Gaies`s one” (dobutamine (μg/kg/min) + (dose of epinephrine [μg/kg/min] + dose of norepinephrine [μg/kg/min] × 100) and show IS mean (μg/kg/min): 177.1.(11)

There are many variations of VIS even not published like in the Hospital and Clinics of Minnesota ‘CRITERIA FOR PEDIATRIC AND YOUNG ADULT ECMO’ where the ISOproterenol is added. http://www.childrensmn.org/web/pdf/209704.pdf

Table 1 * Added brackets and parentheses in the formula.

** Not described what ‘modified’ means.

*** Depends on the group Dopamine and Epinephrine

BIBLIOGRAPHY

1.            Wernovsky G, Wypij D, Jonas RA, Mayer JE, Jr., Hanley FL, Hickey PR, et al. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. A comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation. [Clinical Trial

Comparative Study

Randomized Controlled Trial

Research Support, U.S. Gov't, P.H.S.]. 1995 Oct 15;92(8):2226-35.

2.            Rosenzweig EB, Starc TJ, Chen JM, Cullinane S, Timchak DM, Gersony WM, et al. Intravenous arginine-vasopressin in children with vasodilatory shock after cardiac surgery. Circulation. 1999 Nov 9;100(19 Suppl):II182-6.

3.            Gaies MG, Gurney JG, Yen AH, Napoli ML, Gajarski RJ, Ohye RG, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med. [Research Support, Non-U.S. Gov't]. 2010 Mar;11(2):234-8.

4.            Davidson J, Tong S, Hancock H, Hauck A, da Cruz E, Kaufman J. Prospective validation of the vasoactive-inotropic score and correlation to short-term outcomes in neonates and infants after cardiothoracic surgery. Intensive Care Med. [Research Support, N.I.H., Extramural]. 2012 Jul;38(7):1184-90.

5.            Garcia Guerra G, Robertson CM, Alton GY, Joffe AR, Moez EK, Dinu IA, et al. Health-related quality of life in pediatric cardiac extracorporeal life support survivors. Pediatr Crit Care Med. [Comparative Study

Research Support, Non-U.S. Gov't]. 2014 Oct;15(8):720-7.

6.            Kumar M, Sharma R, Sethi SK, Bazaz S, Sharma P, Bhan A, et al. Vasoactive Inotrope Score as a tool for clinical care in children post cardiac surgery. Indian J Crit Care Med. 2014 Oct;18(10):653-8.

7.            Piva J, Alquati T, Garcia PC, Fiori H, Einloft P, Bruno F. Norepinephrine infusion increases urine output in children under sedative and analgesic infusion. Rev Assoc Med Bras. [Randomized Controlled Trial

Research Support, Non-U.S. Gov't]. 2014 May-Jun;60(3):208-15.

8.            Gaudard P, Mourad M, Eliet J, Zeroual N, Culas G, Rouviere P, et al. Management and outcome of patients supported with Impella 5.0 for refractory cardiogenic shock. Crit Care. 2015;19:363.

9.            Sidhu N, Joffe AR, Doughty P, Vatanpour S, Dinu I, Alton G, et al. Sepsis After Cardiac Surgery Early in Infancy and Adverse 4.5-Year Neurocognitive Outcomes. J Am Heart Assoc. [Research Support, Non-U.S. Gov't]. 2015 Aug;4(8):e001954.

10.          Ventura AM, Shieh HH, Bousso A, Goes PF, Fernandes Ide C, de Souza DC, et al. Double-Blind Prospective Randomized Controlled Trial of Dopamine Versus Epinephrine as First-Line Vasoactive Drugs in Pediatric Septic Shock. Crit Care Med. 2015 Nov;43(11):2292-302.

11.          Rambaud J, Guellec I, Leger PL, Renolleau S, Guilbert J. Venoarterial extracorporeal membrane oxygenation support for neonatal and pediatric refractory septic shock. Indian J Crit Care Med. 2015 Oct;19(10):600-5.