Vasoactive-Inotropic Score (VIS)

Independent clinical validation: pending

Two independent clinical validators will be named here once review is complete.

Validator slot open 1

Validator slot open 2

How it is calculated

VIS = dopamine + dobutamine + 100×epinephrine + 10×milrinone + 10,000×vasopressin + 100×norepinephrine — the original six-drug weighted sum of Gaies et al. 2010. Every rate is in mcg/kg/min except vasopressin, which is in units/kg/min (coefficient 10,000). Each drug is optional; an agent not running contributes 0. There are no branches, floor, ceiling, or age adjustment: the result is a single continuous index (displayed to one decimal place) with no interpretation bands applied.

Limitations and notes

Original six-drug Gaies 2010 VIS = dopamine + dobutamine + 100×epinephrine + 10×milrinone + 10,000×vasopressin(units/kg/min) + 100×norepinephrine. Published extensions (levosimendan ×50, phenylephrine ×10) are intentionally excluded so the output is always a true Gaies VIS; the phenylephrine ×10 coefficient is itself [NEEDS SOURCE] (no directly-fetched primary text). VIS is a continuous index of vasoactive/inotropic support intensity, not a diagnostic test or clinical device, and higher values are an association marker for morbidity/mortality in the cited cohorts, not a treatment trigger. There is no single official cut-point: Davidson 2012 reports a cohort-specific VIS-at-48h threshold of 10.5 in neonates/infants after cardiac surgery, and Gaies 2010 reports an adjusted OR 8.1 (95% CI 3.4–19.2) for high vs low maximum VIS over the first 48h; the exact Gaies high/low dichotomization value is [NEEDS SOURCE] (primary text paywalled). Cut-points do not transfer across populations (sepsis, ECMO, general PICU). VIS is a snapshot; the prognostic quantity in the literature is typically the maximum over a defined window (e.g., first 48h), which the platform must define and label. Per-drug plausible-dose ceilings used for input validation are input-validity bounds, not cited clinical thresholds ([NEEDS SOURCE] — needs a pediatric formulary). Vasopressin unit trap: it is dosed in units/kg/min (coefficient 10,000), the only agent not in mcg/kg/min.

Accepted input ranges

Dopamine — 0–50 mcg/kg/min
Dobutamine — 0–40 mcg/kg/min
Epinephrine (adrenaline) — 0–2 mcg/kg/min
Milrinone — 0–1.5 mcg/kg/min
Vasopressin — 0–0.01 units/kg/min
Norepinephrine (noradrenaline) — 0–2 mcg/kg/min

References

Gaies MG, Gurney JG, Yen AH, Napoli ML, Gajarski RJ, Ohye RG, Charpie JR, Hirsch JC. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med. 2010;11(2):234–238.PMID 19794327 DOI 10.1097/PCC.0b013e3181b806fc
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. 2012;38(7):1184–1190.PMID 22527067 DOI 10.1007/s00134-012-2544-x
Wernovsky G, Wypij D, Jonas RA, Mayer JE Jr, Hanley FL, Hickey PR, Walsh AZ, Chang AC, Castañeda AR, Newburger JW, Wessel DL. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. Circulation. 1995;92(8):2226–2235.PMID 7554206 DOI 10.1161/01.cir.92.8.2226
Sun Y, Wu W, Yao Y. The association of vasoactive-inotropic score and surgical patients' outcomes: a systematic review and meta-analysis. Syst Rev. 2024;13:20.DOI 10.1186/s13643-023-02403-1

Version and changelog

v1.0.0 · Fluids and resuscitation

2026-07-25 v1.0.0 — Initial release: original six-drug Gaies 2010 VIS as a continuous weighted sum.

Important

For use by qualified health professionals as an informational and educational aid. It supports clinical judgment and does not replace it. Verify every result independently before making a clinical decision. This is not a medical device.