Nesiritide in infants and children with congestive heart failure*

Mahle, William T.; Cuadrado, Angel R.; Kirshbom, Paul M.; Kanter, Kirk R.; Simsic, Janet M.

doi:10.1097/01.pcc.0000164634.58297.9a

Cited by 70 publications

(34 citation statements)

References 20 publications

(21 reference statements)

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“…Some of this concern is based on a welldocumented history of reversible, dose-dependent hypotension [11,14,15]. One such incident was seen in our study population.…”

Section: Discussionmentioning

confidence: 90%

“…Although the lack of significantly increased urine output may reflect the small sample size, the inability to detect a difference may be due to differences between the current study population and those in previous studies. The largest study to date [15] included patients with no changes to diuretic and vasoactive medications for 24 h, whereas the practice at our institution was to initiate nesiritide infusion only in patients for whom conventional therapy with diuretic and vasoactive agents were not effective, a qualitatively different circumstance. Nesiritide may be a less effective diuretic in this sicker patient population.…”

Section: Discussionmentioning

confidence: 98%

“…A recent large case series demonstrated improvement in fluid balance in children with heart failure treated with nesiritide [15]. An inclusion criterion for this study, however, was that no changes were made in diuretic or inotropic medications in the 12 h preceding or 24 h following nesiritide initiation.…”

Section: Introductionmentioning

confidence: 96%

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Nesiritide in the management of treatment refractory pediatric heart failure

O’Byrne¹,

Ognibene²,

Morris³

2006

TCIC

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Objective. To describe the impact of nesiritide on critically ill children in heart failure. Design. A retrospective chart review. Setting. Pediatric intensive care unit of a university-affiliated tertiary care hospital. Patients. Fourteen children in heart failure, secondary to dilated cardiomyopathy (n04), rejection (n06) and congenital heart disease (n04), managed with nesiritide while receiving two or more diuretics, two or more vasoactive medications, or increasing vasoactive or diuretic medications during the 12 h prior to nesiritide initiation. Interventions. None. Measurements and main results. The mean arterial pressure, heart rate, and central venous pressure did not change significantly following the administration of nesiritide. Fluid balance and urine output demonstrated suggestive, but non-significant, improvements (p00.13 and 0.1, respectively). One patient experienced an episode of hypotension leading to the discontinuation of nesiritide. No other adverse events were noted. Three of 14 patients exhibited increases in serum creatinine of more than 0.5 mg/dl, including two patients whose creatinine rose above 2 mg/dl or doubled from baseline. Nine of 14 (64%) patients survived to hospital discharge. Conclusion. Nesiritide is well tolerated in pediatric patients who require high-dose or escalating doses of vasoactive or diuretic medications. The use of nesiritide in this population is not associated with significant changes in hemodynamic parameters and may improve fluid mobilization. A prospective study is necessary to rigorously examine its efficacy and safety.

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“…Some of this concern is based on a welldocumented history of reversible, dose-dependent hypotension [11,14,15]. One such incident was seen in our study population.…”

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

Nesiritide in the management of treatment refractory pediatric heart failure

O’Byrne¹,

Ognibene²,

Morris³

2006

TCIC

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“…It was not associated with signifi cant diuresis in most studies [33]. Data related to the use of nesiritide in children with decompensated heart failure is minimal [34][35][36]. Interpretation of this information therefore is problematic.…”

Section: Nesiritidementioning

confidence: 94%

“…The reported starting dosage is 0.001 to 0.005 μg/kg per minute; the reported maximum dosage is 0.02 to 0.03 μg/kg per minute [34][35][36]. In adults, a bolus of 2 μg/kg followed by an infusion of 0.01 μg/kg per minute is the recommended starting dosage.…”

Section: Standard Dosagementioning

confidence: 97%

Pharmaceutical management of decompensated heart failure syndrome in children: Current state of the art and a new approach

Gazit

Oren²

2009

Curr Treat Options Cardio Med

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Prompt initiation of appropriate and intensive treatment in children with decompensated heart failure is crucial to avoid irreversible end-organ dysfunction. Initial management of these children includes transfer to the pediatric cardiac intensive care unit, basic hemodynamic monitoring, and establishment of intravenous access. Inotropic support should be instituted peripherally before obtaining central venous and arterial access. The team should be prepared for emergent intubation and initiation of mechanical circulatory support. Two experienced physicians should work together to obtain vascular access and manage sedation, airway control, and cardiovascular support. Acute heart failure syndrome in children may be related to cardiomyopathy, myocarditis, congenital heart disease, and acute rejection post heart transplantation. Each of these causes requires a different approach. Fulminant myocarditis may lead to severe morbidity and requires intensive support, although its outcome is considered to be good. Acute heart failure related to newly diagnosed dilated cardiomyopathy may represent end-stage heart failure; therefore, long-term mechanical circulatory support and heart transplantation may be considered to avoid other end-organ dysfunction. Hypertrophic cardiomyopathy may lead to acute decompensation due to 1) left ventricular outflow obstruction, 2) restrictive physiology leading to pulmonary hypertension, or 3) myocardial ischemia associated with coronary artery bridging. Decompensated heart failure associated with congenital heart disease usually represents end-stage heart failure and requires thorough evaluation for heart transplantation. Children with single-ventricle physiology who develop decompensated heart failure after a Fontan procedure are not candidates for mechanical circulatory support and therefore may not survive to heart transplantation. Acute heart failure due to posttransplantation acute rejection requires aggressive antirejection treatment, which places these patients at significant risk for overwhelming opportunistic infections. In our opinion, mechanical circulatory support should be initiated early in children who present with end-stage heart failure associated with hemodynamic instability to avoid end-organ damage.

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