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4.
Am J Case Rep ; 22: e934528, 2021 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-34784343

RESUMO

BACKGROUND Reversible cerebral vasoconstriction syndrome (RCVS) is a rare neurological disorder with a complex physiopathology that is not fully understood. Suggested underlying mechanisms include failure of autoregulation, endothelial dysfunction, and oxidative stress. It is characterized by reversible multifocal constriction of the cerebral arteries, and can be triggered by many conditions, including, vasoactive medications (eg, triptans), cerebrovascular events, primary headache disorders, and metabolic causes (eg, hypercalcemia). RCVS can also be associated with pregnancy-related conditions, such as thrombotic thrombocytopenic purpura, eclampsia, and pre-eclampsia. Thunderclap headache is the most common clinical manifestation; however, other symptoms can result from complications of the disease, such as stroke, brain edema, and seizures. Several case reports have been published of an association between RCVS and eclampsia, but to the best of our knowledge, only 3 cases were successfully treated with intravenous milrinone and this is the only patient reported in Saudi Arabia. CASE REPORT We report a case of 25-year-old primigravida woman who presented with acute-onset headache, nausea, elevated blood pressure, and generalized tonic clonic seizure. She was diagnosed as having RCVS secondary to eclampsia based on clinical and radiological features. She was initially started on nimodipine, which is usually the first-line management of RCVS, as well as magnesium sulfate and levetiracetam; however, she only achieved full recovery after starting intravenous milrinone. CONCLUSIONS Milrinone is one of the emerging drugs for treatment of RCVS, and this case report delineates the potential of using the drug, especially in cases refractory to standard therapy.


Assuntos
Transtornos Cerebrovasculares , Eclampsia , Transtornos da Cefaleia Primários , Adulto , Eclampsia/tratamento farmacológico , Feminino , Transtornos da Cefaleia Primários/tratamento farmacológico , Transtornos da Cefaleia Primários/etiologia , Humanos , Milrinona/uso terapêutico , Gravidez , Vasoconstrição
5.
PLoS One ; 16(9): e0254305, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34591850

RESUMO

Congestive heart failure, a prominent cardiovascular disease results primarily from myocardial infarction or ischemia. Milrinone (MRN), a widely used clinical drug for heart failure, improves myocardial contractility and cardiac function through its inotropic and vasodilatory effects. However, lacking target specificity, it exhibits low bioavailability and lower body retention time. Therefore, in this study, angiotensin II (AT1) peptide conjugated human serum albumin nanoparticles (AT1-HSA-MRN-NPs) have been synthesized for targeted delivery of MRN to the myocardium, overexpressing AT1 receptors under heart failure. The NPs were surface functionalized through a covalent conjugation reaction between HSA and AT1. Nanoparticle size was 215.2±4.7 nm and zeta potential -28.8±2.7 mV and cumulative release of MRN was ~72% over 24 hrs. The intracellular uptake of nanoparticles and cell viability was studied in H9c2 cells treated with AT1-MRN-HSA-NPs vs the control non-targeted drug, MRN Lactate under normal, hypoxic and hypertrophic conditions. The uptake of AT1-HSA-MRN-NPs in H9c2 cells was significantly higher as compared to non-targeted nanoparticles, and the viability of H9c2 cells treated with AT1-MRN-HSA-NPs vs MRN Lactate was 73.4±1.4% vs 44.9±1.4%, respectively. Therefore, AT1-HSA-MRN-NPs are safe for in vivo use and exhibit superior targeting and drug delivery characteristics for treatment of heart failure.


Assuntos
Sistemas de Liberação de Medicamentos , Milrinona/farmacologia , Miócitos Cardíacos/efeitos dos fármacos , Nanopartículas/administração & dosagem , Fragmentos de Peptídeos/farmacologia , Albumina Sérica Humana/química , Animais , Transporte Biológico , Cardiotônicos/química , Cardiotônicos/farmacologia , Sobrevivência Celular , Portadores de Fármacos , Humanos , Milrinona/química , Miócitos Cardíacos/citologia , Miócitos Cardíacos/metabolismo , Nanopartículas/química , Fragmentos de Peptídeos/química , Ratos
6.
Int J Surg ; 94: 106080, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34500081

RESUMO

BACKGROUND: To explore the feasibility and effectiveness of controlled low central venous pressure(CLCVP)induced by milrinone during hepatectomy, and its influence on perioperative hemodynamics, blood loss and patients' recovery, comparing with the traditional method by nitroglycerin. METHODS: 52 patients who underwent elective open hepatectomy were enrolled in the study and randomly divided into two groups: milrinone (M) group and nitroglycerin (NG) group. Milrinone was infused with the rate of 0.5 µg/kg/min in group M, while nitroglycerin was given 0.2-0.5 µg/kg/min in group NG to maintain CVP≤ 5 mmHg during liver resection. The demographic variables, data of the operative procedure and intraoperative hemodynamics were recorded. The postoperative recovery profiles and pre- and post-operative haematological markers of vital organs were also collected and compared. RESULTS: 1. The blood loss of group M, no matter during liver resection or in the whole procedure, was both less than that of group NG (P < 0.05), so did the hemoglobin detected by blood gas analysis (P < 0.05). Meanwhile, time of hepatectomy and hepatic hilum occlusion were shorter in group M (P < 0.05). 2. Compared with the NG group, cardiac index (CI) and stroke volume index (SVR) were higher in group M in the operation. The norepinephrine dosage necessary in the operation was of no difference in two groups (P > 0.05). 3. Drainage indwelling time and postoperative hospital stay of group M were shorter than that of group NG (P < 0.05). Most of the blood biomarkers increased on postoperative day (POD)-1, and returned to the preoperative level on POD-7 without inter-group difference (P > 0.05). Brain natriuretic peptide precursor (Pro-BNP) in group M was higher than NG group on POD-1 (P < 0.05), and the statistical difference disappeared on POD-7. CONCLUSION: Milrinone can effectively maintain a controlled low central venous pressure during hepatectomy. Compared with nitroglycerin, milrinone can reduce the amount of blood loss, with the benefit of better manifestation of hemodynamics and enhanced postoperative recovery.


Assuntos
Hepatectomia , Milrinona , Nitroglicerina , Pressão Venosa Central , Hemodinâmica , Humanos
7.
N Engl J Med ; 385(6): 516-525, 2021 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-34347952

RESUMO

BACKGROUND: Cardiogenic shock is associated with substantial morbidity and mortality. Although inotropic support is a mainstay of medical therapy for cardiogenic shock, little evidence exists to guide the selection of inotropic agents in clinical practice. METHODS: We randomly assigned patients with cardiogenic shock to receive milrinone or dobutamine in a double-blind fashion. The primary outcome was a composite of in-hospital death from any cause, resuscitated cardiac arrest, receipt of a cardiac transplant or mechanical circulatory support, nonfatal myocardial infarction, transient ischemic attack or stroke diagnosed by a neurologist, or initiation of renal replacement therapy. Secondary outcomes included the individual components of the primary composite outcome. RESULTS: A total of 192 participants (96 in each group) were enrolled. The treatment groups did not differ significantly with respect to the primary outcome; a primary outcome event occurred in 47 participants (49%) in the milrinone group and in 52 participants (54%) in the dobutamine group (relative risk, 0.90; 95% confidence interval [CI], 0.69 to 1.19; P = 0.47). There were also no significant differences between the groups with respect to secondary outcomes, including in-hospital death (37% and 43% of the participants, respectively; relative risk, 0.85; 95% CI, 0.60 to 1.21), resuscitated cardiac arrest (7% and 9%; hazard ratio, 0.78; 95% CI, 0.29 to 2.07), receipt of mechanical circulatory support (12% and 15%; hazard ratio, 0.78; 95% CI, 0.36 to 1.71), or initiation of renal replacement therapy (22% and 17%; hazard ratio, 1.39; 95% CI, 0.73 to 2.67). CONCLUSIONS: In patients with cardiogenic shock, no significant difference between milrinone and dobutamine was found with respect to the primary composite outcome or important secondary outcomes. (Funded by the Innovation Fund of the Alternative Funding Plan for the Academic Health Sciences Centres of Ontario; ClinicalTrials.gov number, NCT03207165.).


Assuntos
Cardiotônicos/uso terapêutico , Dobutamina/uso terapêutico , Milrinona/uso terapêutico , Choque Cardiogênico/tratamento farmacológico , Agonistas Adrenérgicos beta/uso terapêutico , Idoso , Cardiotônicos/efeitos adversos , Comorbidade , Dobutamina/efeitos adversos , Método Duplo-Cego , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Milrinona/efeitos adversos , Inibidores da Fosfodiesterase 3/uso terapêutico , Choque Cardiogênico/mortalidade
8.
Crit Care ; 25(1): 289, 2021 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-34376218

RESUMO

BACKGROUND: Cardiogenic shock (CS) is associated with significant morbidity and mortality. The impact of beta-blocker (BB) use on patients who develop CS remains unknown. We sought to evaluate the clinical outcomes and hemodynamic response profiles in patients treated with BB in the 24 h prior to the development of CS. METHODS: Patients with CS enrolled in the DObutamine compaREd to MIlrinone trial were analyzed. The primary outcome was a composite of all-cause mortality, resuscitated cardiac arrest, need for cardiac transplant or mechanical circulatory support, non-fatal myocardial infarction, transient ischemic attack or stroke, or initiation of renal replacement therapy. Secondary outcomes included the individual components of the primary composite and hemodynamic response profiles derived from pulmonary artery catheters. RESULTS: Among 192 participants, 93 patients (48%) had received BB therapy. The primary outcome occurred in 47 patients (51%) in the BB group and in 52 (53%) in the no BB group (RR 0.96; 95% CI 0.73-1.27; P = 0.78) throughout the in-hospital period. There were fewer early deaths in the BB group (RR 0.41; 95% CI 0.18-0.95; P = 0.03). There were no differences in other individual components of the primary outcome or in hemodynamic response between the two groups throughout the remainder of the hospitalization. CONCLUSIONS: BB therapy in the 24 h preceding the development of CS did not negatively influence clinical outcomes or hemodynamic parameters. On the contrary, BB use was associated with fewer deaths in the early resuscitation period, suggesting a paradoxically protective effect in patients with CS. Trial registration ClinicalTrials.gov Identifier: NCT03207165.


Assuntos
Antagonistas Adrenérgicos beta/efeitos adversos , Cardiotônicos/administração & dosagem , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Choque Cardiogênico/tratamento farmacológico , Antagonistas Adrenérgicos beta/farmacologia , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Cardiotônicos/uso terapêutico , Dobutamina/efeitos adversos , Dobutamina/farmacologia , Dobutamina/uso terapêutico , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Milrinona/efeitos adversos , Milrinona/farmacologia , Milrinona/uso terapêutico , Mortalidade/tendências , Avaliação de Resultados em Cuidados de Saúde/métodos , Choque Cardiogênico/fisiopatologia
9.
Eur Heart J Acute Cardiovasc Care ; 10(7): 712-720, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34382063

RESUMO

AIMS: Cardiogenic shock (CS) is a state of low cardiac output resulting in end-organ hypoperfusion. Despite high in-hospital mortality rates, little evidence exists regarding the optimal mean arterial pressure (MAP) target in CS. We therefore evaluated the relationship between achieved MAP and clinical outcomes in patients with CS. METHODS AND RESULTS: We performed a post hoc analysis of the CAPITAL DOREMI trial: a randomized, double-blind trial comparing dobutamine to milrinone in patients with CS. We divided patients into a high MAP group (average MAP ≥ 70 mmHg over the 36 h following randomization), and a low MAP group (average MAP < 70 mmHg). Our primary outcome included in-hospital all-cause mortality, resuscitated cardiac arrest, need for cardiac transplantation or mechanical circulatory support, non-fatal myocardial infarction, transient ischaemic attack or stroke, or initiation of renal replacement therapy. In total, 71 (37.0%) patients achieved an average MAP < 70 mmHg, and 121 (63.0%) achieved an average MAP ≥ 70 mmHg. The primary outcome occurred in 48 (67.6%) patients in the low MAP group and 51 (42.2%) patients in the high MAP group [adjusted relative risk (aRR) 0.70; 95% confidence interval (CI) 0.53-0.92; P = 0.01]. All-cause mortality occurred in 41 (57.8%) and 35 (28.9%) patients in the low and high MAP groups, respectively (aRR 0.56; 95% CI 0.40-0.79; P < 0.01). There were no significant differences in any secondary outcomes between each group. CONCLUSIONS: In patients with CS treated with inotrope therapy, low MAP is associated with worse clinical outcomes. Randomized data evaluating optimal MAP targets in CS is needed to guide medical therapy.


Assuntos
Pressão Arterial , Choque Cardiogênico , Cardiotônicos/uso terapêutico , Dobutamina , Humanos , Milrinona , Choque Cardiogênico/tratamento farmacológico , Choque Cardiogênico/etiologia
10.
Toxicol Appl Pharmacol ; 427: 115652, 2021 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-34298059

RESUMO

Exposure to phosphine (PH3) presents with a host of diverse, non-specific symptoms that span multiple organ systems and is characterized by a high mortality rate. While a comprehensive mechanism for PH3 poisoning remains inconclusive, prior studies have implicated cardiac failure and circulatory compromise as potential pathways central to PH3-induced mortality. In this study, milrinone (MLR), a phosphodiesterase-3 inhibitor used to treat cardiac failure, was investigated as a potential countermeasure for PH3 poisoning. Lethality, physiological responses, and behavioral changes were evaluated in telemetrized female rats pretreated with water (sham) or one of three doses of MLR (40, 200, or 600 µg/kg) and exposed to PH3 (660 ppm for 25-40 min; 16,500-26,400 ppm × min). Animals receiving prophylactic administration of 600 µg/kg of MLR had nominally improved survivability compared to sham animals, although median lethal concentration-time and time of death did not differ substantially between treatment groups. Changes in respiration and behavior induced by PH3 appeared largely unaffected by MLR pretreatment, regardless of dose. Conversely, MLR pretreatment alleviated some aspects of PH3-induced cardiac function impairment, with slight dose-dependent effects observed for cardiac contractility, mean arterial pressure, and QRS duration. Together, these results illustrate the importance of circulatory compromise in PH3 poisoning and highlight the potential viability of MLR as a potential countermeasure option or part of a countermeasure regimen when administered prophylactically at 600 µg/kg.


Assuntos
Débito Cardíaco/efeitos dos fármacos , Cardiotônicos/administração & dosagem , Inseticidas/envenenamento , Milrinona/administração & dosagem , Fosfinas/envenenamento , Mecânica Respiratória/efeitos dos fármacos , Animais , Débito Cardíaco/fisiologia , Relação Dose-Resposta a Droga , Avaliação Pré-Clínica de Medicamentos/métodos , Feminino , Exposição por Inalação/efeitos adversos , Dose Letal Mediana , Profilaxia Pré-Exposição/métodos , Ratos , Ratos Sprague-Dawley , Mecânica Respiratória/fisiologia , Taxa de Sobrevida/tendências
11.
Int J Clin Pract ; 75(11): e14689, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34331721

RESUMO

BACKGROUND: The use of dobutamine in patients with sepsis is questionable. Some studies reported milrinone was used as an alternative inotropic agent. We aim to evaluate whether milrinone is better than dobutamine in patients with sepsis. METHODS: Based on the analysis of MIMIC III public database, we performed a big data, real-world study. According to the use of dobutamine or milrinone, patients were categorised as the dobutamine group or milrinone group. We used propensity score matched (PSM) analysis to adjust for confoundings. The primary outcome was hospital mortality. RESULTS: In this study, after screening 38 605 patients, 235 patients with sepsis were included. One hundred and eighty-three patients were in the dobutamine group and 52 patients were in the milrinone group. For the primary outcome of hospital mortality, there was no significant between-group difference (73/183 in dobutamine group vs 23/52 in milrinone group, OR 0.84, 95% CI 0.45-1.56; P = .574). After adjusting for confoundings between groups by PSM analysis, hospital mortality was consistent with the overall result (50% vs 41.3%, OR 1.42, 95% CI 0.68-2.97; P = .349). For the secondary outcomes, more patients in milrinone group received RRT use (46.2% vs 22.4%, P = .001), had longer length of ICU stay (20.97 ± 22.84 days vs 11.10 ± 11.54 days, P = .004) and hospital stay (26.14 ± 25.13 days vs 14.51 ± 13.11 days, P = .002) than those in dobutamine group. CONCLUSIONS: Compared with dobutamine, the use of milrinone did not decrease hospital mortality in patients with sepsis. Furthermore, milrinone was associated with more RRT therapy, longer length of ICU stay and hospital stay than dobutamine.


Assuntos
Milrinona , Sepse , Big Data , Cardiotônicos/uso terapêutico , Dobutamina/uso terapêutico , Humanos , Estudos Retrospectivos , Sepse/tratamento farmacológico
13.
Andrologia ; 53(8): e14128, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34091938

RESUMO

This experimental study aims to evaluate the efficacy of milrinone against ischaemia-reperfusion injury due to testicular torsion/detorsion. Group 1 was defined as the control group. Testicular torsion/detorsion model was performed in Group 2. Group 3 had similar procedures to the rats in Group 2. In addition, 0.5 mg/kg of milrinone was administered intraperitoneally immediately after testicular torsion in Group 3. Histopathological examinations indicated a dramatic improvement in terms of inflammation, haemorrhage, oedema, congestion, Cosentino and Johnson scores in Group 3 compared to Group 2 (p = .037, p = .045, p = .018, p = .040, p = .033 and p = .03 respectively). Blood biochemical analyses, superoxide dismutase (SOD), glutathione peroxidase (GSH-px) activity and total antioxidant status (TAS) levels increased significantly in Group 3 compared to Group 2 (p = .001, p = .024 and p < .001). Malondialdehyde (MDA), protein carbonyl (PC), interleukin 1beta (IL-1beta), tumour necrosis factor-alpha (TNF-alpha) and total oxidant status (TOS) levels decreased in Group 3 compared to Group 2 (p = .001, p = .018, p < .001, p = .036 and p = .002 respectively). Tissue biochemical analyses determined an increase in SOD and GSH-px activity in Group 3 compared to Group 2, while PC and MDA levels were reduced (p = .001, p < .001, p = .038 and p < .001 respectively). Milrinone attenuates ischaemia-reperfusion injury that causes highly harmful effects due to testicular torsion/detorsion.


Assuntos
Traumatismo por Reperfusão , Torção do Cordão Espermático , Animais , Humanos , Masculino , Malondialdeído , Milrinona , Ratos , Ratos Wistar , Traumatismo por Reperfusão/tratamento farmacológico , Traumatismo por Reperfusão/prevenção & controle , Torção do Cordão Espermático/complicações , Torção do Cordão Espermático/tratamento farmacológico , Testículo
14.
J Cardiothorac Vasc Anesth ; 35(8): 2521-2527, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33985881

RESUMO

In this report, the clinical evolution of a 72-year-old patient transferred to the surgical intensive care unit after cardiac surgery is described. The presence of a pulsatile Doppler signal of the common femoral vein was noted after surgery. On postoperative day 5, diuretics in addition to a combination of inhaled epoprostenol and milrinone were associated with normalization of femoral vein pulsatility. The observations seen in peripheral venous flow reinforce the hypothesis that pulsatility of the common femoral vein represents an associated echocardiographic sign of right ventricular dysfunction and may be used to monitor systemic venous congestion. Pulsatility in the venous system may be improved by reducing volume overload and improving right ventricular function.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Disfunção Ventricular Direita , Idoso , Veia Femoral/diagnóstico por imagem , Veia Femoral/cirurgia , Humanos , Milrinona , Veia Porta , Fluxo Pulsátil
15.
Ann Card Anaesth ; 24(2): 217-223, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33884979

RESUMO

Background: Prophylactic milrinone is commonly used to prevent Low Cardiac Output Syndrome (LCOS) after pediatric cardiac surgery. This study compares the use of levosimendan with milrinone when used as the primary inotrope following pediatric cardiac surgery. Subjects and Methods: Forty infants undergoing corrective surgery for congenital heart disease were recruited during the study and randomized into two groups (group L and group M). During rewarming, a loading dose of levosimendan or milrinone was administered followed by a 24-hour infusion of the chosen inotrope. Echocardiographic variables were measured postoperatively. Statistical analysis was done with SPSS-20 computer package. Association between the variables was found by independent t test. P < 0.05 was considered statistically significant. Results: Mean age and weight of the patient in Group L was 8.55 ± 5.83 months and 6.05 ± 2.09 kgs, while that in group M was 6.85 ± 3.57 months and 5.26 ± 2.11 kgs. 4 patients (20%) treated with levosimendan had LCOS in comparison with 6 (30%) patients in those treated with milrinone. Echocardiographic parameters in both groups L and M were comparable (cardiac index 3.47 ± 0.76 vs 3.72 ± 1.05 L/min/m2, EF 66.10 ± 7.82% vs 59.34 ± 10.74%, stroke volume index 25.4 ± 6.3 vs 27.74 ± 10.35 mL/m2). The duration of ventilation, ICU stay and hospital stay were lesser in group L (12.75 ± 9.69, 35.95 ± 12.11, 119.10 ± 46.397 vs 23.60 ± 22.03, 51.20 ± 29.92, 140.20 ± 52.65 hours). Conclusions: The incidence of LCOS was lesser in those patients treated with levosimendan, when compared with those treated with milrinone. Cardiac index and stroke volume index were comparable between the two groups. Thus, levosimendan provides a non-inferior alternative to milrinone when used as the primary inotrope following pediatric cardiac surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Piridazinas , Débito Cardíaco , Baixo Débito Cardíaco/prevenção & controle , Cardiotônicos/uso terapêutico , Criança , Método Duplo-Cego , Humanos , Hidrazonas/uso terapêutico , Lactente , Milrinona/uso terapêutico , Piridazinas/uso terapêutico , Simendana , Resultado do Tratamento
17.
J Perinatol ; 41(9): 2345-2354, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33850285

RESUMO

OBJECTIVE: Characterize the impact of milrinone on arterial pressure of neonates with persistent hypoxemic respiratory failure (HRF) and hypoxic ischemic encephalopathy (HIE) treated with inhaled nitric oxide and therapeutic hypothermia (TH). STUDY DESIGN: Retrospective cohort study. Arterial pressure was assessed hourly for 24 h. The primary outcome was change in diastolic arterial pressure (DAP). RESULTS: 56 patients were included [(i) cases: HIE/TH who received milrinone (n = 9), (ii) Milrinone controls (n = 17), (iii) HIE controls (n = 30)]. Baseline demographics, severity of HRF and arterial pressure were comparable between groups. Only milrinone treated patients with HIE/TH had a marked drop in DAP in the first hour, which persisted for more than 12 h despite escalation in inotropes (p = 0.008). CONCLUSION: Milrinone treated patients with HRF and HIE/TH develop profound reduction in DAP and require escalation of cardiovascular support. The risk benefit profile of milrinone should be considered and pharmacological studies are warranted to evaluate drug metabolism and clearance in this population.


Assuntos
Hipotermia Induzida , Hipóxia-Isquemia Encefálica , Hemodinâmica , Humanos , Hipóxia , Hipóxia-Isquemia Encefálica/tratamento farmacológico , Recém-Nascido , Milrinona/uso terapêutico , Estudos Retrospectivos
18.
J Cardiothorac Vasc Anesth ; 35(7): 2073-2078, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33736911

RESUMO

OBJECTIVES: The aim of this study was to investigate whether milrinone infusion improved one-year survival in patients who underwent the Norwood-Sano procedure. DESIGN: A retrospective observational study. SETTING: A single-institution university hospital. PARTICIPANTS: Children who underwent the Norwood-Sano procedure from January 2008 to December 2014. INTERVENTIONS: Patients were categorized into two groups: group E+D, who received routine epinephrine and dopamine infusion, and group M, who received routine milrinone infusion for intra- and postoperative inotropic support. MEASUREMENTS AND MAIN RESULTS: The primary outcome of this study was one-year survival after the Norwood-Sano procedure. A total of 45 patients were included (group E+D, 22; group M, 23). One-year survival in group M was significantly higher than that in group E+D (95.7% [22/23] v 72.7% [16/22], p = 0.03). A Kaplan-Meier curve also showed that one-year survival in group M was significantly higher than that in group E+D (p = 0.04), from the result of the log-rank test. The number of patients who had any arrhythmias in the intensive care unit (ICU) was significantly lower in group M than in group E+D (21.7% [5/23] v 50% [11/22], p = 0.03). The duration of ICU stay did not have statistical difference between groups (group M 19; interquartile range [IQR], 15-28) v group E+D 19.5 (IQR, 16.3-35.5) days, p = 0.57). CONCLUSIONS: Perioperative milrinone infusion improved the mortality after the Norwood-Sano procedure. Potential advantages of milrinone compared with epinephrine are fewer arrhythmias and better systemic perfusion, which could decrease lethal cardiac events in the ICU.


Assuntos
Síndrome do Coração Esquerdo Hipoplásico , Procedimentos de Norwood , Criança , Humanos , Milrinona , Estudos Retrospectivos , Resultado do Tratamento
20.
Pediatr Crit Care Med ; 22(7): e402-e409, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33739957

RESUMO

OBJECTIVES: We compared the effect of two inodilators, levosimendan and milrinone, on the plasma levels of myocardial injury biomarkers, that is, high-sensitivity troponin T and heart-type fatty acid binding protein, and on N-terminal prohormone of brain natriuretic peptide as a biomarker of ventricular function. We hypothesized that levosimendan could attenuate the degree of myocardial injury when compared with milrinone. DESIGN: A post hoc, nonprespecified exploratory secondary analysis of the Milrinone versus Levosimendan-1 trial (ClinicalTrials.gov Identifier: NCT02232399). SETTING: Two pediatric tertiary university hospitals. PATIENTS: Infants 1-12 months old, diagnosed with ventricular septal defect, complete atrioventricular septal defect, or Tetralogy of Fallot undergoing corrective surgery with cardiopulmonary bypass. INTERVENTIONS: Seventy patients received a loading dose of either levosimendan or milrinone at the start of cardiopulmonary bypass followed by an infusion of the respective drug, which continued for 26 hours. MEASUREMENTS AND MAIN RESULTS: Plasma levels of the three cardiac biomarkers were measured prior to the initiation of cardiopulmonary bypass and 2, 6, and 24 hours after weaning from cardiopulmonary bypass. In both groups, the levels of high-sensitivity troponin T and heart-type fatty acid binding protein were highest at 2 hours post cardiopulmonary bypass, whereas the highest level of N-terminal prohormone of brain natriuretic peptide occurred at 24 hours post cardiopulmonary bypass. There was no significant difference in the biomarkers' plasma levels between the study groups over time. Neither was there a significant difference in the postoperative peak plasma levels of the cardiac biomarkers. CONCLUSIONS: In this post hoc analysis of the MiLe-1 trial, there was no demonstrable difference in the postoperative cardiac biomarker profile of myocardial injury and ventricular function when comparing infants managed in the perioperative period with levosimendan versus milrinone.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Milrinona , Simendana , Biomarcadores , Ponte Cardiopulmonar , Cardiotônicos/efeitos adversos , Cardiotônicos/uso terapêutico , Humanos , Lactente , Milrinona/efeitos adversos , Milrinona/uso terapêutico , Simendana/efeitos adversos , Simendana/uso terapêutico
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