Outcome of inotropic therapy: is less always more?

Positive inotropic agents are widely used in the management of the critical ill patient presenting with low cardiac output state. Different inotropic agents are available, and different effects on hemodynamic endpoints may be recognized, but data on relevant clinical endpoints are scarce. A growing body of literature suggests that overuse of inotropes may have detrimental effects on cardiomyocytes, resulting in an increased risk of morbidity and mortality. The present review will summarize recent literature, focusing on outcome studies among adult patients related to use of inotropes in different clinical settings.

Use of inotropic therapy shows a manifold variation between hospitals and individual providers even after risk standardization. No recent studies have shown inotropic therapy to provide short-term and long-term improvement of morbidity and mortality in patients with advanced nonsurgical heart failure or septic shock or as part of goal-directed treatment in high-risk noncardiac surgery. Levosimendan may show beneficial effect on mortality in cardiac surgery.

A 'less is more' approach may show to be appropriate when relating to routine use of inotropes. Inotropic therapy should be restricted to patients with heart failure and clinical signs of end-organ hypoperfusion.