Adverse Effects of Dopamine on Systemic Hemodynamic Status and Oxygen Transport in Neonates After the Norwood Procedure

Li, Jia; Zhang, Gencheng; Holtby, Helen; Humpl, Tilman; Caldarone, Christopher A.; Arsdell, Glen S. Van; Redington, Andrew N.

doi:10.1016/j.jacc.2006.07.038

Cited by 75 publications

(76 citation statements)

References 29 publications

(30 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A recent study of dopamine in neonates after the Norwood procedure showed adverse effects on oxygen transport and hemodynamic status, contrary to traditional thinking. 10 In a randomized trial of carvedilol in children with heart failure, Shaddy et al 11 showed that carvedilol did not Values represent the proportion of patients in each demographic subgroup who received an off-label drug in the particular class. Values in bold type indicate a significant difference (PϽ0.001) between the proportion of patients in a demographic category receiving an off-label drug.…”

Section: Discussionmentioning

confidence: 99%

Off-Label Use of Cardiovascular Medications in Children Hospitalized With Congenital and Acquired Heart Disease

Pasquali

Hall

Slonim

et al. 2008

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

Background-Many barriers exist to conducting pediatric cardiovascular (CV) trials, and the majority of therapies used are not evidence based. Recent legislation has aimed to stimulate pediatric research and improve drug labeling. This study describes off-label use of CV medications in children hospitalized with congenital and acquired CV disease. Methods and Results-The 2005 Pediatric Health Information System database was queried for patients with CVInternational Classification of Disease, Ninth Revision codes who received CV medications. Off-label use (patient younger than US Food and Drug Administration-approved age) was described. Multivariate analysis used Poisson regression to model the number of CV drugs received off-label. There were 31 432 patients included (median age, 10.4 months; interquartile range, 30 days to 6.8 years). Congenital heart disease (67%) was the most common diagnosis.Other diagnoses included hypertension, arrhythmia, myocarditis/cardiomyopathy, pulmonary hypertension, rheumatic fever/endocarditis, and heart transplant. Seventy-eight percent received Ն1 CV medication off-label, and 31% received Ն3 CV medications off-label. The most commonly used CV medications were furosemide, epinephrine, dopamine, lidocaine, and milrinone. The latter 3 (prescribed in 69% of patients) were used off-label in all cases. Medications studied under recent federal initiatives were prescribed in only 20% of patients, and were still used off-label 62% of the time. In multivariate analysis, heart transplant recipients (odds ratio 1.7; 95% CI 1.5 to 1.9) were most likely to receive a greater number of off-label CV medications. Conclusions-Despite recent legislation, off-label use of CV medications in the pediatric population is common. These data highlight the need for further study to determine which treatments should be used more frequently and which are unsafe or ineffective in children hospitalized with CV disease. (Circ Cardiovasc Qual Outcomes. 2008;1:74-83.)

show abstract

Section: Discussionmentioning

confidence: 99%

Off-Label Use of Cardiovascular Medications in Children Hospitalized With Congenital and Acquired Heart Disease

Pasquali

Hall

Slonim

et al. 2008

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

show abstract

“…430,431 In one study in single ventricle postoperative cardiac patients, dopamine increased oxygen consumption while not improving blood pressure or cardiac output. 438 …”

Section: Epinephrinementioning

confidence: 99%

Part 14: Pediatric Advanced Life Support

Kleinman¹,

Chameides²,

Schexnayder³

et al. 2010

Circulation

907

304

View full text Add to dashboard Cite

“…3,4 Consequently, we have applied this technique to compare these parameters in contemporaneous patients undergoing Hybrid and Norwood procedures.…”

mentioning

confidence: 99%

Comparison of the Profiles of Postoperative Systemic Hemodynamics and Oxygen Transport in Neonates After the Hybrid or the Norwood Procedure

Zhang

Benson

et al. 2007

Circulation

Self Cite

View full text Add to dashboard Cite

Background-After the Norwood procedure, early postoperative neonatal physiology is characterized by hemodynamic instability and imbalance of oxygen transport that is commonly attributed to surgical myocardial injury and a systemic inflammatory response to cardiopulmonary bypass (CPB). Because the Hybrid procedure (arterial duct stenting and bilateral pulmonary artery banding) avoids CPB, cardioplegic arrest, and circulatory arrest, we hypothesized that the Hybrid procedure is associated with superior postoperative hemodynamics and oxygen transport. Methods and Results-Oxygen consumption (VO 2 ) was continuously measured using respiratory mass spectrometry for 72 hours after Hybrid (nϭ6) and Norwood (nϭ13) procedures. Arterial, superior vena cava, and pulmonary venous blood gases and pressures were measured at 2-to 4-hour intervals to calculate systemic and pulmonary blood flows (Qs, Qp), and systemic vascular resistance (SVR), total pulmonary vascular resistance including pulmonary arterial band or B-T shunt (tPVR), cardiac output (CO), oxygen delivery (DO 2 ), and oxygen extraction ratio (ERO 2 ). Rate-pressure product was calculated as heart rateϫsystolic arterial pressure. When compared with the Norwood procedure, the early postoperative Hybrid patients had lower CO, higher SVR, and higher Qp:Qs ratios. In addition, the DO 2 and VO 2 were both lower in the Hybrids with higher ERO 2 and lactate levels. This early postoperative pattern reversed after 48 hours. Conclusions-Although Hybrid procedure avoids CPB and cardioplegic arrest, the early hemodynamic profile is not superior to the Norwood in terms of cardiac output and control of pulmonary blood flow. These data strongly suggest that a "hands off" approach to postoperative care in Hybrid patients may not be appropriate in patients with preoperative diminished myocardial function; and in such patients a Norwood-derived management strategy (afterload reduction and inotropic support) should be considered.

show abstract

Adverse Effects of Dopamine on Systemic Hemodynamic Status and Oxygen Transport in Neonates After the Norwood Procedure

Abstract: Dopamine induces a significant increase in VO2 in neonates after the Norwood procedure, and termination is associated with an improved balance of VO2-DO2. These data further emphasize the importance of understanding changes in VO2 as well as DO2 in infants after cardiac surgery.

Cited by 75 publications

References 29 publications

Off-Label Use of Cardiovascular Medications in Children Hospitalized With Congenital and Acquired Heart Disease

Off-Label Use of Cardiovascular Medications in Children Hospitalized With Congenital and Acquired Heart Disease

Part 14: Pediatric Advanced Life Support

Comparison of the Profiles of Postoperative Systemic Hemodynamics and Oxygen Transport in Neonates After the Hybrid or the Norwood Procedure

Contact Info

Product

Resources

About