Successful weaning from cardiopulmonary bypass with central venous prostaglandin E1 and left atrial norepinephrine infusion in patients with acute pulmonary hypertension

Autor: A. Menichetti, Andrea A. Cogliati, Elisabetta Pasotti, Luigi Tritapepe, Ugo Papalia, Paolo Voci
Rok vydání: 1999
Předmět:
Adult
Male
Cardiac Catheterization
Catheterization
Central Venous
medicine.medical_specialty
Hypertension
Pulmonary
Vasodilator Agents
Cardiac Output
Low
Critical Care and Intensive Care Medicine
law.invention
Norepinephrine (medication)
Norepinephrine
chemistry.chemical_compound
Refractory
law
Left atrial
Cardiopulmonary bypass
Humans
Vasoconstrictor Agents
Medicine
Weaning
Heart Atria
Pulmonary Wedge Pressure
Alprostadil
Cardiac Surgical Procedures
Infusions
Intravenous
Prostaglandin E1
Cardiopulmonary Bypass
business.industry
Middle Aged
medicine.disease
Pulmonary hypertension
Cardiac surgery
Treatment Outcome
chemistry
Anesthesia
Acute Disease
Drug Therapy
Combination
Female
Vascular Resistance
lipids (amino acids
peptides
and proteins)
business
circulatory and respiratory physiology
medicine.drug
Popis: Postoperative pulmonary hypertension increases the mortality risk in cardiac surgery. We have used central venous prostaglandin E1 (PGE1) and left atrial norepinephrine (NE) infusion to wean from cardiopulmonary bypass (CPB) patients with refractory postoperative pulmonary hypertension.Observational, nonrandomized study.Department of Cardiac Surgery in a university hospital.We studied 10 nonconsecutive American Society of Anesthesiologists III and New York Heart Association class III-IV patients with postoperative pulmonary hypertension and low cardiac output syndrome preventing separation from CPB.Patients received right atrial PGE1 (31.5 +/- 6.26 ng/kg/min) and left atrial NE (0.11 +/- 0.02 microg/kg/min) infusion. Hemodynamic data were obtained before CPB (T0), after CPB under maximal inotropes and vasodilator infusion (T1), 10 mins (T2) and 12 hrs (T3) after PGE1 and NE infusion, and 48 hrs after withdrawal of PGE1 and NE (T4).All patients were successfully weaned from CPB and survived. The biatrial infusion of PGE1 and NE caused a dramatic reduction in mean pulmonary artery pressure (from 42.8 +/- 5.1 mm Hg at T1 to 28.5 +/- 2.6 mm Hg at T2 and 20.5 +/- 2.0 mm Hg at T4), pulmonary vascular resistance index (from 1158 +/- 269 dyne x sec/cm5 x m2 at T1 to 501 +/- 99 dyne x sec/cm5 x m2 at T2 and 246 +/- 50 dyne x sec/cm5 x m2 at T4), and pulmonary-to-systemic vascular resistance index ratio (from 0.61 +/- 0.17 at T1 to 0.20 +/- 0.04 at T2 and 0.11 +/- 0.03 at T4). Cardiac index increased from 1.7 +/- 0.2 L/min/m2 at T1 to 2.3 +/- 0.2 L/min/m2 at T2 and 2.9 +/- 0.1 L/min/m2 at T4.In patients with refractory postoperative pulmonary hypertension, the combined administration of low-dose PGE1 in the right atrium and NE in the left atrium is an effective means to wean patients from cardiopulmonary bypass.
Databáze: OpenAIRE
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