Vasoactive-Inotropic Score (VIS) Calculator
Vasoactive-Inotropic Score (VIS) Calculator
Six infusion rates and six published multipliers, giving one figure for the intensity of cardiovascular support after cardiopulmonary bypass — not a dose equivalence, and not interchangeable with one.
Vasoactive-inotropic score
6 infusions → one index80 kg adult after cardiopulmonary bypass: noradrenaline 0.1 µg/kg/min, adrenaline 0.05 µg/kg/min, dobutamine 5 µg/kg/min, milrinone 0.5 µg/kg/min, vasopressin 0.0004 units/kg/min, no dopamine
The formula, the cohort it came from, and what it is not
all in µg/kg/min except vasopressin, in units/kg/min
- the derivation cohort
- 174 infants aged 0 to 6 months admitted to one academic paediatric cardiothoracic intensive care unit after cardiopulmonary bypass surgery between August 2007 and June 2008 — about 43 per cent neonates and 39 per cent with functional single ventricle physiology. Hourly doses of every vasoactive drug were recorded for the first 48 hours and the maximum VIS taken. A high maximum VIS carried an adjusted odds ratio of 8.1 (95% CI 3.4–19.2, p < 0.001) for a composite of death, cardiac arrest, mechanical circulatory support, renal replacement therapy or neurological injury, and was also associated with longer intensive care stay, longer ventilation and longer time to negative fluid balance
- no Gaies threshold is quoted here, deliberately
- the derivation paper split patients into high and low maximum VIS, but its full text could not be read for this page and the numeric cut-off it used is therefore not known here. Rather than quote a threshold from a secondary source, this page quotes none: the bands come from a named adult cohort instead, and say so
- a time window, not an instant
- both cohorts used the maximum score over a defined window — 48 hours in the infants, and the early intensive care period in the adults. A single spot value computed on this page is a snapshot of one moment and is not what either study measured. The strata below apply to a maximum, not to a reading taken at an arbitrary hour
- it is NOT a dose equivalence
- adrenaline and noradrenaline carry the same multiplier here, and dobutamine — which is not a vasopressor at all — carries the same weight as dopamine. That tells you what kind of object this is: an index of how much cardiovascular support is running, used to compare patients and to track one patient over time. For converting between vasopressors, which is a different question with different and disagreeing published ratios, see noradrenaline-equivalent dose. The two numbers are not interchangeable and a patient on dobutamine alone has a positive VIS and a zero noradrenaline equivalent
- the unit trap
- vasopressin’s multiplier is 10 000 and its published unit is units per kilogram per minute, while prescriptions are almost always in units per minute. Entering 0.03 instead of 0.000375 adds 300 points instead of 3.75. The adult validation paper itself prints the formula per kilogram and then reports its own doses per minute, so the inconsistency is in the literature and not only at the bedside
- later versions exist
- several groups have extended the index — the literature read for this page names a later modification and a 2022 proposal by name — and this page computes the original six-drug form as published in 2010, which is the form the adult strata above were calculated with
Worked example
80 kg adult after cardiopulmonary bypass: noradrenaline 0.1 µg/kg/min, adrenaline 0.05 µg/kg/min, dobutamine 5 µg/kg/min, milrinone 0.5 µg/kg/min, vasopressin 0.0004 units/kg/min, no dopamine
Dopamine 0 + dobutamine 5 = 5
Adrenaline 100 × 0.05 = 5; noradrenaline 100 × 0.1 = 10
Milrinone 10 × 0.5 = 5; vasopressin 10 000 × 0.0004 = 4
Total 29.0, which falls in the published 21–38 group — 21.1 per cent in-hospital mortality in a cohort of 493 adults in cardiogenic shock
Vasopressin here is 0.0004 units/kg/min, which in an 80 kg patient is 0.032 units/min — a very ordinary infusion. Enter 0.032 by mistake and the score becomes 345
Notice where the score comes from: the two weighted catecholamines contribute 15 of the 29 points from doses of 0.1 and 0.05 µg/kg/min, while 5 µg/kg/min of dobutamine contributes 5. The multipliers, not the doses, dominate
The same infusions through noradrenaline-equivalent dose give a very different figure, because that calculation excludes dobutamine and milrinone entirely and weights the rest by vasopressor potency rather than by this index's multipliers
The six terms
| Drug | Unit | Multiplier | Contribution at a typical rate |
|---|---|---|---|
| Dopamine | µg/kg/min | 1 | 5 at 5 µg/kg/min |
| Dobutamine | µg/kg/min | 1 | 5 at 5 µg/kg/min |
| Adrenaline (epinephrine) | µg/kg/min | 100 | 5 at 0.05 µg/kg/min |
| Noradrenaline (norepinephrine) | µg/kg/min | 100 | 10 at 0.1 µg/kg/min |
| Milrinone | µg/kg/min | 10 | 3.75 at 0.375 µg/kg/min |
| Vasopressin | units/kg/min | 10 000 | 3.75 at 0.000375 units/kg/min, which is 0.03 units/min at 80 kg |
In-hospital mortality by VIS group, in adults with cardiogenic shock
| VIS group | In-hospital mortality | Adjusted odds ratio for death |
|---|---|---|
| 1 to 10 | 8.2% | reference |
| 11 to 20 | 14.1% | not significant as reported |
| 21 to 38 | 21.1% | not significant as reported |
| 39 to 85 | 32.0% | 3.85 (95% CI 1.60–9.22) |
| Above 85 | 65.7% | 10.83 (95% CI 4.43–26.43) |
An index of support, not a conversion between drugs
The vasoactive-inotropic score adds six infusion rates with six fixed multipliers and returns one number for how much cardiovascular support a patient is receiving. It was published in 2010 from 174 infants aged under six months in a single paediatric cardiothoracic intensive care unit after cardiopulmonary bypass, where the maximum score over the first 48 hours carried an adjusted odds ratio of 8.1 for a composite of death, cardiac arrest, mechanical circulatory support, renal replacement therapy or neurological injury. It has since been used far outside that population, which is why this page labels every band with the cohort it came from.
What the index is not is a dose equivalence, and the multipliers give that away. Adrenaline and noradrenaline carry the same weight, 100, although no equivalence scheme treats them as interchangeable. Dobutamine, which is not a vasopressor, carries the same weight as dopamine. Milrinone is in it at all. The score is measuring the intensity of pharmacological support, not the vasopressor dose, and the distinction is practical: a patient on dobutamine and milrinone alone has a substantial VIS and a noradrenaline-equivalent dose of zero. Those are two different questions and this site keeps them on two pages.
Two things will get a VIS wrong at the bedside. The first is units. The formula is per kilogram per minute throughout, and vasopressin’s multiplier of 10 000 means that entering a prescribed 0.03 units/min instead of the per-kilogram 0.000375 adds 300 points rather than 3.75. The adult validation study quoted here prints the formula per kilogram and then tabulates its own vasopressin doses per minute, so the confusion is in the literature too. The second is the time window: both the paediatric derivation and the adult validation used the maximum score over a defined period, and a spot value is not the same quantity.
The bands on this page are the published quintile groups from 493 adults in cardiogenic shock in one Korean cardiac intensive care unit between 2012 and 2015, with in-hospital mortality rising from 8.2 per cent to 65.7 per cent across them. They are used because the derivation paper’s own high-versus-low cut-off could not be read for this page, and quoting an unsourced threshold would be worse than quoting a sourced one from a different population and saying so. For the haemodynamics behind the infusions, see systemic vascular resistance and cardiac output by the Fick principle. A score’s output is a cohort frequency, not this patient’s probability: a stratum in which 9 per cent had an event describes that stratum, not which 9 per cent. Every figure here comes from a named cohort, and cohorts differ in case mix, era, outcome definition and treatment; where your own institution’s protocol differs, it takes precedence. This page reports what a stratum predicted in a named study. It recommends no action.
Frequently asked questions
What units does vasopressin go in?
Units per kilogram per minute, with a multiplier of 10 000. This is the commonest error on the score. A prescription of 0.03 units/min in an 80 kg patient is 0.000375 units/kg/min and contributes 3.75 points; entering 0.03 contributes 300. The adult validation paper itself prints the formula per kilogram and reports its doses per minute, so check which you are reading.
Is the VIS the same as a noradrenaline-equivalent dose?
No, and they are not convertible. A noradrenaline equivalent converts vasopressors to a common potency and excludes inotropes; the VIS weights six drugs including dobutamine and milrinone with multipliers that treat adrenaline and noradrenaline as equal. A patient on dobutamine alone has a positive VIS and a zero noradrenaline equivalent. Use the VIS to describe how much support is running and the equivalent dose to compare vasopressor intensity.
Why are the bands from adults when the score came from infants?
Because the derivation paper’s own numeric cut-off between high and low maximum VIS could not be read for this page, and a threshold taken from a secondary source would be unsourced. The bands used instead are the published quintile groups from 493 adults in cardiogenic shock in one centre, and every band says so. Applying adult cardiogenic shock strata to a postoperative infant is not supported by either paper.
Should I use a spot value or the maximum?
The published associations are with the maximum score over a window — 48 hours in the infant derivation cohort, and the early intensive care period in the adult validation. This page computes a single value from the rates you enter, which is a snapshot. If you are comparing against the published strata, compute it at the patient’s peak support rather than at an arbitrary hour.
Does a high VIS mean the patient needs mechanical support?
This page does not answer that, and the published study it takes its bands from was explicitly a comparison of medical therapy against extracorporeal support in which the two regression curves crossed at a VIS of 130. What the strata report is in-hospital mortality by group in that cohort: 8.2 per cent at the bottom and 65.7 per cent above 85. The decision is not a calculation.
Related calculators
References
- Gaies MG, Gurney JG, Yen AH, 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. Abstract and repository record read; the full text, and with it the numeric cut-off that separated high from low maximum VIS, could not be reached.
- Na SJ, Chung CR, Cho YH, et al. Vasoactive inotropic score as a predictor of mortality in adult patients with cardiogenic shock: medical therapy versus ECMO. Rev Esp Cardiol (Engl Ed). 2019;72(1):40–47. The source of the adult strata used here, and one of the two independent sources for the formula.
- A 2024 Journal of Thoracic Disease study reproducing the same VIS formula drug by drug and multiplier by multiplier, read as the second independent source for it.
Not medical advice. For healthcare professionals and education. Reference intervals vary by laboratory and assay — always use your own laboratory's. Never base a dose or a treatment decision on this page alone. Full disclaimer at calcengines.com/disclaimer/