- Enter each running infusion rate. All drug rates are in µg/kg/min except vasopressin (units/kg/min). Leave any drug the patient is not receiving blank or at 0.
- For vasopressin, enter the rate directly in units/kg/min, or use the helper: type the common units/min rate and the patient's weight (kg) and the page converts it to units/kg/min for you.
- The VIS total, the leading contributor, and the severity band update automatically as you type.
- Read the score as a trend — record the early-postoperative maximum and the value at 24–48 h, and reassess frequently alongside lactate and perfusion pressure.
All computation runs in your browser; no values are stored or transmitted.
When to Use
Use the VIS to put an objective number on how much vasoactive support a critically ill patient currently requires. It is most useful for tracking the severity and trajectory of shock — comparing the early-postoperative or 24–48 h maximum across time points, or between patients — and as a complement to lactate, urine output, and perfusion pressure when deciding on escalation, mechanical support, or goals-of-care discussions.
Appropriate population
Patients on one or more continuous vasopressor/inotrope infusions: post-cardiac-surgery (the original validated setting in infants and children), and increasingly adults in cardiogenic, septic, or distributive shock. Most informative as a serial marker — record the maximum value during the first 24–48 hours of support.
When NOT to over-read it
VIS is a severity marker, not a treatment target — do not titrate drugs to a number. Thresholds and band cutoffs vary between studies and populations, and the original weights predate newer agents and dosing practices, so a single value is less meaningful than the trend. Always interpret it alongside perfusion (lactate, mentation, urine output), the underlying diagnosis, and the full clinical picture.
Pearls & Pitfalls
The weights tell the story
The big multipliers are deliberate: epinephrine and norepinephrine are weighted ×100, milrinone and dopexamine ×10, and vasopressin ×10,000, while dopamine and dobutamine count 1:1. So a patient on a small dose of norepinephrine can carry a far higher VIS than one on a large dose of dopamine — the score reflects potency and escalation, not just the number of drugs.
Mind the vasopressin units
Vasopressin is the common stumbling block: it is entered in units/kg/min, not µg/kg/min. A typical adult on 0.03 units/min at 70 kg is ≈ 0.000429 units/kg/min, which — at a ×10,000 weight — contributes ≈ 4.3 points to the VIS. Use the weight + units/min helper to avoid order-of-magnitude errors.
Pitfalls
(1) Band thresholds vary between studies — treat <10 / 10–20 / >20 as a common convention, not a hard rule, with >45 marking profound support. (2) The score is a snapshot; a single value matters less than the trajectory and the early-postoperative or 24–48 h maximum. (3) The original weights predate widespread use of some agents and modern dosing, so cross-institution comparisons need care. (4) Never titrate therapy to the VIS — it grades severity, it does not set a target.
Why Use It
Shock severity is hard to summarize: two patients can be on "pressors" yet require wildly different amounts of support. The VIS condenses the full vasoactive regimen into one weighted number, turning a list of infusions into a single, comparable measure of hemodynamic burden. Originally derived and validated in infants after cardiopulmonary bypass — where a higher early-postoperative VIS predicted mortality, prolonged ventilation, and the need for renal replacement — it has since been extended to adult cardiac surgery and general critical care, where rising or sustained high scores again track with worse outcomes. Used as a trend alongside lactate and perfusion pressure, it provides an objective, reproducible way to communicate how sick a patient is and how their support is evolving.
Vasoactive-Inotropic Score (VIS)
Enter each running infusion rate to compute the VIS. All drug rates are in µg/kg/min except vasopressin (units/kg/min). The total, leading contributor, and severity band appear once at least one drug is entered.
⚕ Gaies MG, et al. Pediatr Crit Care Med. 2010;11(2):234–238. VIS = dopamine + dobutamine + 100×epinephrine + 100×norepinephrine + 10×milrinone + 10,000×vasopressin + 10×dopexamine. The score grades the cumulative burden of hemodynamic support; it is a severity marker, not a treatment target, and band thresholds vary between studies. Interpret as a trend alongside lactate, perfusion pressure, and the clinical picture. For licensed clinicians; not a substitute for individualized assessment.
Next Steps
Use the VIS to grade severity and frame the next decision — not to set a drug target.
- Low VIS (<10): modest support. Continue to address the underlying cause of shock; reassess perfusion (lactate, urine output, mentation) and wean as tolerated.
- Moderate VIS (10–20): substantial support — watch the trend closely. Confirm volume status, source control, and that the diagnosis is correct; anticipate the trajectory over the next hours.
- High VIS (>20), and especially very high (>45): profound, escalating support associated with worse outcomes including AKI and the need for renal replacement. Reconsider the diagnosis, look for reversible drivers, and discuss mechanical circulatory support and goals of care.
- Track the VIS as a trend — record the early-postoperative or 24–48 h maximum — and pair it with the renal & abdominal perfusion pressure and vasopressor & inotrope dosing when adjusting support.
Evidence & References
Formula (Gaies 2010)
| Component | Weight in VIS |
|---|---|
| Dopamine (µg/kg/min) | × 1 |
| Dobutamine (µg/kg/min) | × 1 |
| Epinephrine (µg/kg/min) | × 100 |
| Norepinephrine (µg/kg/min) | × 100 |
| Milrinone (µg/kg/min) | × 10 |
| Dopexamine (µg/kg/min) | × 10 |
| Vasopressin (units/kg/min) | × 10,000 |
VIS = dopamine + dobutamine + 100×epinephrine + 100×norepinephrine + 10×milrinone + 10,000×vasopressin + 10×dopexamine.
Severity bands (common convention)
| VIS | Interpretation |
|---|---|
| < 10 | Low — modest hemodynamic support |
| 10 – 20 | Moderate — substantial support |
| > 20 | High — heavy support, worse outcomes |
| > 45 | Very high — profound support |
Thresholds vary across studies and populations; the bands above are a widely used convention. The score is most meaningful as a trend (e.g. the early-postoperative or 24–48 h maximum), not as an isolated value.
References
- Gaies MG, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med. 2010;11(2):234–238.
- Koponen T, et al. Vasoactive-inotropic score and the prediction of morbidity and mortality after cardiac surgery in adults. Br J Anaesth. 2019;122(4):428–436.
- Belletti A, et al. Vasoactive-Inotropic Score: Evolution, Clinical Utility, and Pitfalls. J Cardiothorac Vasc Anesth. 2021;35(10):3067–3077.
