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Titolo:
MILRINONE - SYSTEMIC AND PULMONARY HEMODYNAMIC-EFFECTS IN NEONATES AFTER CARDIAC-SURGERY
Autore:
CHANG AC; ATZ AM; WERNOVSKY G; BURKE RP; WESSEL DL;
Indirizzi:
CHILDRENS HOSP,DEPT CARDIOL,CARDIAC INTENS CARE OFF,FARLEY 653,300 LONGWOOD AVE BOSTON MA 02115 CHILDRENS HOSP,DEPT CARDIOL,CARDIAC INTENS CARE OFF BOSTON MA 02115 CHILDRENS HOSP,DEPT CARDIOVASC SURG BOSTON MA 02115 HARVARD UNIV,SCH MED,DEPT PEDIAT BOSTON MA 02115 HARVARD UNIV,SCH MED,DEPT SURG BOSTON MA 02115
Titolo Testata:
Critical care medicine
fascicolo: 11, volume: 23, anno: 1995,
pagine: 1907 - 1914
SICI:
0090-3493(1995)23:11<1907:M-SAPH>2.0.ZU;2-X
Fonte:
ISI
Lingua:
ENG
Soggetto:
CONGESTIVE HEART-FAILURE; POSITIVE INOTROPIC AGENTS; MYOCARDIAL-CONTRACTILITY; INTRAVENOUS MILRINONE; VASODILATOR ACTIONS; OXYGEN-CONSUMPTION; AMRINONE; PERFORMANCE; DOBUTAMINE; PRESSURE;
Keywords:
PHOSPHODIESTERASE INHIBITORS; MILRINONE; AMRINONE; NEONATES; CARDIAC SURGERY; CARDIAC OUTPUT; OXYGEN CONSUMPTION; HEMODYNAMICS; HEART; CARDIAC EMERGENCIES;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
66
Recensione:
Indirizzi per estratti:
Citazione:
A.C. Chang et al., "MILRINONE - SYSTEMIC AND PULMONARY HEMODYNAMIC-EFFECTS IN NEONATES AFTER CARDIAC-SURGERY", Critical care medicine, 23(11), 1995, pp. 1907-1914

Abstract

Objective: To evaluate the hemodynamic effects of intravenous milrinone in neonates with low cardiac output after cardiac surgery. Design: Prospective cohort study. Setting: Pediatric cardiac intensive care unit. Patients: Ten neonates with low cardiac output (cardiac index of less than or equal to 3.0 L/min/m(2)) after corrective cardiac surgery were enrolled in the study. The neonates' ages ranged from 3 to 27 days (median 5) and their weights ranged from 2.0 to 4.8 kg (median 3.7). The diagnoses were: transposition of the great arteries (n = 6, including two with ventricular septal defect), tetralogy of Fallot (n = 2),truncus arteriosus (n = 1), and total anomalous pulmonary venous connection (n = 1). Interventions: Milrinone was intravenously administered in three stages: a) baseline stage, in which patients had a stable hemodynamic status, ventilation and gas exchange, hemostasis, and body temperature; b) loading stage, in which a 50 mu g/kg intravenous loading dose of milrinone was administered over 15 mins; and c) infusion stage, in which milrinone was continuously infused at 0.50 mu g/kg/min for 30 mins. Measurements and Main Results: The mean heart rate increased after the loading stage (149 +/- 13 to 163 +/- 12 beats/min, p < .01) but slowed during the infusion stage (154 +/- 11 beats/min, p < .01vs. loading stage). Both right and left atrial pressures were loweredin all ten neonates. Compared with baseline, mean arterial pressure decreased after the loading stage (66 +/- 12 to 57 +/- 10 mm Hg, p < .01) but did not decrease further at the infusion stage (59 +/- 12 mm Hg); changes in mean pulmonary arterial pressure were comparable. Cardiac index increased from a baseline mean of 2.1 +/- 0.5 to 3.0 +/- 0.8 L/min/m(2) (p < .01) with the loading stage, and was maintained at 3.1 /- 0.6 L/min/m(2) during the infusion stage. Systemic vascular resistance index decreased below baseline values with loading, from 2136 +/-432 to 1336 +/- 400 dyne . sec/cm(5) . m(2) (p < .01), and pulmonary vascular resistance index also decreased with loading dose of milrinone, from 488 +/- 160 to 360 +/- 120 dyne . sec/cm(5) . m(2) (p < .01). There was no change in the rate pressure index, an indirect measurement of myocardial oxygen consumption, throughout the study. Conclusions:Administration of milrinone in neonates with low cardiac output aftercardiac surgery lowers filling pressures, systemic and pulmonary arterial pressures, and systemic and pulmonary vascular resistances, whileimproving cardiac index. Milrinone increases heart rate without altering myocardial oxygen consumption. While milrinone appears to be effective and safe during short-term use, the relative distribution of inotropic and vasodilatory properties of milrinone remains to be elucidated.

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Documento generato il 07/08/20 alle ore 06:46:11