Prevention of Low Cardiac Output Syndrome After Pediatric Cardiac Surgery: A Double-Blind Randomized Clinical Pilot Study Comparing Dobutamine and Milrinone
| Autor: | Christian Balmer, Dominique Bettex, Christoph Buerki, Oskar Baenziger, Hitendu Dave, Maja I. Hug, Vincenzo Cannizzaro, Anna Cavigelli-Brunner |
|---|---|
| Přispěvatelé: | University of Zurich, Cavigelli-Brunner, Anna |
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Male
Cardiac output Cardiac Output Low Pilot Projects 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine Pediatrics law.invention 0302 clinical medicine law Dobutamine Postoperative Period Prospective Studies Child Cardiopulmonary Bypass Perinatology Cardiac surgery and Child Health Anesthesia Child Preschool Milrinone Female 10023 Institute of Intensive Care Medicine 2706 Critical Care and Intensive Care Medicine medicine.drug Cardiac function curve Heart Defects Congenital medicine.medical_specialty Cardiotonic Agents Adolescent 610 Medicine & health Intensive Care Units Pediatric 03 medical and health sciences Afterload Double-Blind Method medicine Cardiopulmonary bypass Humans 10220 Clinic for Surgery 2735 Pediatrics Perinatology and Child Health business.industry Infant 10020 Clinic for Cardiac Surgery Blood pressure 030228 respiratory system 10036 Medical Clinic Pediatrics Perinatology and Child Health business |
| DOI: | 10.5167/uzh-151479 |
| Popis: | Objectives Dobutamine and milrinone are commonly used after open-heart surgery to prevent or treat low cardiac output syndrome. We sought to compare efficacy and safety of these drugs in pediatric patients. Design Prospective, single-center, double-blinded, randomized clinical pilot study. Setting Tertiary-care university children's hospital postoperative pediatric cardiac ICU. Patients After written consent, 50 consecutive patients (age, 0.2-14.2 yr; median, 1.2 yr) undergoing open-heart surgery for congenital malformations were included. Interventions After cardiopulmonary bypass, a continuous infusion of either dobutamine or milrinone was administered for the first 36 postoperative hours. Maximum dose: dobutamine 6 µg/kg/min, milrinone 0.75 µg/kg/min. Measurements and main results There were no significant differences in demographic data, complexity of surgery, and intraoperative characteristics between the two study groups (dobutamine vs milrinone). Efficacy was defined as need for additional vasoactive support, which did not differ between groups (dobutamine 61% vs milrinone 67%; p = 0.71). Sodium nitroprusside was used more often in the dobutamine group (42% vs 13%; p = 0.019). Systolic blood pressure showed a trend toward higher values in the dobutamine group, whereas both drugs increased heart rate early postoperatively. Echocardiography demonstrated a consistently good cardiac function in both groups. Central venous oxygen saturation, serum lactate levels, urine output, time to chest tube removal, length of mechanical ventilation, ICU, and hospital stay were similar in both groups. Both drugs were well tolerated, no serious adverse events occurred. Conclusions Dobutamine and milrinone are safe, well tolerated, and equally effective in prevention of low cardiac output syndrome after pediatric cardiac surgery. The hemodynamic response of the two drugs is comparable. In uncomplicated cases, a trend toward the more cost-saving dobutamine might be anticipated; however, milrinone demonstrated a trend toward higher efficacy in afterload reduction. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|