Abstract
Objective
The objective of the study was to perform a descriptive approach of the current use of catecholamines by French physicians.
Design
A questionnaire of 12 questions with 4 items established by a group of French intensivists.
Population
French physicians from 433 departments working in the following practicing areas: intensive care unit (ICU), emergency department, and pre-hospital setting.
Measurements
Responding physicians were asked about the catecholamine that they would select in various clinical settings.
Results
The response rate was 82%. Of the responding physicians, 277 (78%) worked in an ICU, 28 (8%) in an emergency department, and 21 (6%) in a pre-hospital setting. Dobutamine was chosen for patients with cardiogenic shock by 90% of the respondents. Norepinephrine was the first choice agent as vasopressor in patients with septic shock in 52% of the cases. Dopamine was selected in a clinical setting requiring an optimization of regional blood flow, as in the concept of high-risk surgical patients. Dopexamine was used as a second or third choice agent to improve regional blood flow and cardiac output. The indications of epinephrine for anaphylactic shock and cardio-circulatory arrest were obvious for more than 90% of responding physicians.
Conclusion
A lack of standardization appears in the use of catecholamines by French physicians, particularly for improvement of regional circulation and management of high-risk surgical patients. Guidelines that define the place of each catecholamine in these settings are required to improve the quality of prescription.
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Appendix
Appendix
Questionnaire
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1.
Among the following adrenergic agents, which one would you use as first, second, third or fourth choice for the treatment of patients with cardiogenic shock?
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Dobutamine/Dopexamine/Milrinone-Amrinone/Epinephrine
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2.
Among the following vasopressor agents, which one would you use as first, second, third or fourth choice for the treatment of patients with septic shock?
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Dopamine/Norepinephrine/Epinephrine/Phenylephrine
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3.
If a patient with septic shock is already receiving a vasopressor, among the following inotropic agents, which one would you use as first, second, third or fourth choice?
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Dobutamine/Dopexamine/Milrinone-Amrinone/Epinephrine
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4.
If a patient with septic shock is already receiving an inotropic agent, among the following vasopressor agents, which one would you use as first, second, third or fourth choice?
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Phenylephrine/Norepinephrine/Epinephrine/Dopamine
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5.
In order to improve regional blood flow, among the following inotropic agents, which one would you use as first, second, third or fourth choice?
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Dopamine/Isoprenalline/Dopexamine/Dobutamine
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6.
In order to improve renal blood flow, among the following inotropic agents, which one would you use as first, second, third or fourth choice?
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Dopexamine/Dobutamine/Isoprenalline/Dopamine
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7.
In order to manage high-risk surgical patients, among the following inotropic agents, which one would you use as first, second, third or fourth choice?
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Dopexamine/Dobutamine/Isoprenalline/Dopamine
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8.
In order to manage high-risk surgical patients, among the following vasopressor agents, which one would you use as first, second, third or fourth choice?
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Dopamine/Norepinephrine/Epinephrine/Phenylephrine
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9.
When would you use epinephrine as the first choice agent?
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Cardiogenic shock/Septic shock/Anaphylactic shock/Cardiocirculatory arrest
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10.
When you prescribe an inotropic agent, what type of monitoring do you use?
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Arterial catheter/Swan-Ganz catheter/Transesophageal Doppler/Gastric tonometry
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11.
What is your primary specialty? (one response)
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ICU physician/Emergency physician/Pre-hospital physician
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12.
You are working in a: (one response)
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Teaching hospital/Community hospital/Private hospital/Pre-hospital care
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Leone, M., Vallet, B., Teboul, JL. et al. Survey of the use of catecholamines by French physicians. Intensive Care Med 30, 984–988 (2004). https://doi.org/10.1007/s00134-004-2172-1
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DOI: https://doi.org/10.1007/s00134-004-2172-1