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Titolo:
Milrinone therapy in catecholamine-dependent critically ill patients with heart failure
Autore:
Siostrzonek, P; Koreny, M; Delle-Karth, G; Haumer, M; Koller-Strametz, J; Heinz, G;
Indirizzi:
Univ Vienna, Dept Cardiol, Cardiol Intens Care Unit, A-1090 Vienna, Austria Univ Vienna Vienna Austria A-1090 tens Care Unit, A-1090 Vienna, Austria
Titolo Testata:
ACTA ANAESTHESIOLOGICA SCANDINAVICA
fascicolo: 4, volume: 44, anno: 2000,
pagine: 403 - 409
SICI:
0001-5172(200004)44:4<403:MTICCI>2.0.ZU;2-C
Fonte:
ISI
Lingua:
ENG
Soggetto:
CARDIOGENIC-SHOCK; PHOSPHODIESTERASE INHIBITION; INTRACORONARY INFUSION; INTRAVENOUS MILRINONE; DOBUTAMINE; HEMODYNAMICS;
Keywords:
milrinone; catecholamine dependency; heart failure;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
24
Recensione:
Indirizzi per estratti:
Indirizzo: Siostrzonek, P Univ Vienna, Dept Cardiol, Cardiol Intens Care Unit, Wahringer Gurtel 18-20,6J, A-1090 Vienna, Austria Univ Vienna Wahringer Gurtel 18-20,6J Vienna Austria A-1090
Citazione:
P. Siostrzonek et al., "Milrinone therapy in catecholamine-dependent critically ill patients with heart failure", ACT ANAE SC, 44(4), 2000, pp. 403-409

Abstract

Background: Treatment with the PDE-III inhibitor milrinone improves hemodynamics in patients with heart failure. We examined whether therapy with milrinone is safe and effective in critically ill patients with catecholamine-dependent heart failure and whether treatment with milrinone facilitates weaning from prolonged catecholamine therapy. Methods: Twenty adult patients with reduced left ventricular function and prolonged (7+/-4 days) catecholamine therapy in whom attempts at catecholamine weaning had failed were examined. Patients were prospectively randomised either to group A (addition of a fixed dose of 0.5 mu g.kg(-1).min(-1) milrinone to catecholamine therapy) or to group B (continued catecholamine therapy without milrinone). Dobutamine and norepinephrine treatment and fluidintake were titrated according to predefined hemodynamic goals. Hemodynamic parameters, fluid requirements and catecholamine dose were monitored. Results: After 24 h of study treatment goup A showed a significant increase in cardiac index (2.2+/-0.4 1 min(-1).m(-2) to 2.7+/-0.5 l min(-1).m(-2);P<0.005), a decrease in systemic vascular resistance (1427+/-609 dyn.s.cm(-5) to 951+/-184 dyn.s.cm(-5); P<0.005), required lower doses of dobutamine(5.9+/-4.2 mu g.kg(-1).min(-1) to 2.2+/-3.3 mu g.kg(-1).min(-1); P<0.02), but showed a tendency for higher vasoconstrictor (0.14+/-0.16 mu g.kg(-1).min(-1) to 0.29+/-0.43 mu g.kg(-1).min(-1); P=n.s.) and fluid requirements (1404+/-2257 ml/24 h to +-2508+/-1873 ml/24 h; P=n.s.). No significant changes occurred in group B. Weaning from catecholamine therapy was more often achieved in group A and more milrinone treated patients were discharged alive from the ICU (80% vs. 30%; P<0.05). Conclusions: Milrinone improves central hemodynamics and may facilitate weaning from prolonged catecholamine support in critically ill patients with heart failure. Its administration in this subset of critically ill patientsis safe, but eventually is associated with additional vasoconstrictor and fluid requirements. (C) Acta Anaesthesiologica Scandinavica 44 (2000).

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Documento generato il 07/07/20 alle ore 15:08:28