Vaso-active inotropic scores: Clinical value, pros and cons

Vasoactive-inotropic scores (VIS) are used as predictors of outcome in pediatric and adult patients with cardiogenic shock undergoing cardiac surgery. VIS is calculated by combining the doses of vasoactive and inotropic drugs using weighted formulas. However, similar VIS values may reflect different hemodynamic states such as cardiogenic shock, vasoplegic shock, or mixed shock. This review summarizes the current literature to further evaluate its clinical utility, and its strengths and limitations.

A systematic literature search was performed with keywords "vasoactive" and "inotropic score". We included English-language human studies with full text availability. Extracted data included VIS formulas, publication year, study population, patient characteristics, timing of VIS assessment, cut-off values, and clinical outcomes.

Ninety-two studies evaluating VIS were identified and 16 different inotropic scores were identified. We divided the groups of patients who needed vasoactive and/or inotropic drugs support for vasoplegia, cardiac dysfunction, or mixed shock states. There was a wide variation in the timing of VIS assessment (pre-operative to 72 h after surgery), and in the VIS cut-off values, limiting the comparison between studies. Moreover, orally administered or intravenous bolus medications were not taken into account.

VIS is an easy bedside tool that has been shown to be associated with clinical outcomes. However, current formulas do not consider dose-dependent actions of inotropes or vasopressors, other medications used, and the etiology of the support. There is also substantial heterogeneity in the timing of VIS calculation and cut-off values over different patient populations.