Your browser doesn't support javascript.
loading
Milrinone Acts as a Vasodilator But Not an Inotrope in Children After Cardiac Surgery-Insights From Wave Intensity Analysis.
Rahiman, Sarfaraz; Kowalski, Remi; Kwok, Sit Yee; Matha, Sunit; Jones, Bryn; Smolich, Joseph J; Mynard, Jonathan P; Butt, Warwick; Millar, Johnny.
Affiliation
  • Rahiman S; Department of Paediatric Intensive Care, Queensland Children's Hospital, Brisbane, Qld, Australia.
  • Kowalski R; School of Medicine, University of Queensland, Brisbane, Qld, Australia.
  • Kwok SY; Department of Cardiology, Royal Children's Hospital, Melbourne, Parkville, VIC, Australia.
  • Matha S; Department of Paediatric Cardiology, Queen Mary Hospital, Hong Kong.
  • Jones B; Department of Paediatric Intensive Care, Monash Children's Hospital, Melbourne, VIC, Australia.
  • Smolich JJ; Department of Cardiology, Royal Children's Hospital, Melbourne, Parkville, VIC, Australia.
  • Mynard JP; Heart Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
  • Butt W; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
  • Millar J; Department of Cardiology, Royal Children's Hospital, Melbourne, Parkville, VIC, Australia.
Crit Care Med ; 48(11): e1071-e1078, 2020 11.
Article de En | MEDLINE | ID: mdl-32932352
OBJECTIVES: Milrinone is an inodilator widely used in the postoperative management of children undergoing cardiac surgery. The literature supporting its inotropic effect is sparse. We sought to study the effect of milrinone on the vasculature and its effects on the ventricular function using wave intensity analysis. We also intended to evaluate the feasibility of using wave intensity analysis by the bedside. DESIGN: prospective single-center observational study. SETTING: PICU of a tertiary children's hospital. PATIENTS: Children (< 18 yr) admitted to PICU following cardiac surgery who required to be commenced on a milrinone infusion. INTERVENTIONS: Echocardiography and Doppler ultrasound assessments for wave intensity analysis were performed prior to commencing milrinone and 4-6 hours after milrinone infusion. MEASUREMENTS AND MAIN RESULTS: Wave intensity analysis was successfully performed and analyzed in 15 of 16 patients (94%). We identified three waves-a forward compression wave, backward compression wave, and forward decompression wave. The waves were described with their cumulative intensity and wave-related pressure change. There was a 26% reduction in backward compression wave cumulative intensity following the introduction of milrinone. Other variables (backward compression wave cumulative intensity/forward compression wave cumulative intensity ratio, backward compression wave wave-related pressure change, backward compression wave wave-related pressure change/forward compression wave wave-related pressure change ratio) consistent with vasodilation also decreased after milrinone. It also decreased the vascular wavespeed by 7.1% and increased the distensibility of the vessels by 14.6%. However, it did not increase forward compression wave cumulative intensity, a variable indicating the systolic force generated by the ventricle. Forward decompression wave cumulative intensity indicating ventricular early diastolic relaxation also did not change. CONCLUSIONS: In a cohort of children recovering in PICU after having undergone cardiac surgery, we found that milrinone acted as a vasodilator but did not demonstrate an improvement in the contractility or an improved relaxation of the left ventricle as assessed by wave intensity analysis. We were able to demonstrate the feasibility and utility of wave intensity analysis to further understand ventriculo-vascular interactions in an intensive care setting.
Sujet(s)

Texte intégral: 1 Collection: 01-internacional Base de données: MEDLINE Sujet principal: Vasodilatateurs / Cardiotoniques / Milrinone / Procédures de chirurgie cardiaque Type d'étude: Observational_studies / Prognostic_studies Limites: Female / Humans / Infant / Male Langue: En Journal: Crit Care Med Année: 2020 Type de document: Article Pays d'affiliation: Australie Pays de publication: États-Unis d'Amérique

Texte intégral: 1 Collection: 01-internacional Base de données: MEDLINE Sujet principal: Vasodilatateurs / Cardiotoniques / Milrinone / Procédures de chirurgie cardiaque Type d'étude: Observational_studies / Prognostic_studies Limites: Female / Humans / Infant / Male Langue: En Journal: Crit Care Med Année: 2020 Type de document: Article Pays d'affiliation: Australie Pays de publication: États-Unis d'Amérique