Use of milrinone in the management of haemodynamic instability following duct ligation

Sehgal, Arvind; Francis, Johny Vakayil; Lewis, Anthony

doi:10.1007/s00431-010-1296-2

Cited by 23 publications

(24 citation statements)

References 22 publications

(24 reference statements)

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“…Milrinone (an inodilator with highly desirable lusitropic properties) has been shown to improve low-cardiac-output state in post-cardiac surgery infants [2]. Recently, it has been shown to be useful in the management of postsurgical duct ligation myocardial failure [50]. There are very limited data on its role in the preterm transitional circulation [41,42].…”

Section: Framework To Optimize Therapymentioning

confidence: 99%

Haemodynamically unstable preterm infant: an unresolved management conundrum

Sehgal

2011

Eur J Pediatr

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While extremely low-birthweight infants are at a higher risk of haemodynamic instability, management strategies can be highly variable and may lack scientific validation. The aetiology of cardiovascular compromise can be diverse. Volume replacements, cardiotropes (dobutamine, dopamine, epinephrine and milrinone) and hydrocortisone supplementation are common interventions. Most often, therapy is driven by protocol, is based on poorly validated clinical information or is based on the premise that "one therapy fits all". A physiology-driven approach is most needed during transition from intrauterine to extrauterine life surrounding preterm birth, when rapid changes in cardiovascular adaptation occur. The physiologically important determinants of neonatal haemodynamics include cardiac output and systemic vascular resistance, blood pressure, as well as individual organ vascular resistances and blood flows. Three key variables with impact on neonatal haemodynamics, haemodynamically significant ductus arteriosus, systemic blood flow and left ventricular afterload, as well as related therapeutic dilemmas are addressed. Among the novel technologies and approaches presently available, targeted neonatal echocardiography performed by the clinician, used in conjunction with the clinical context, has the potential to better define pathophysiology. A framework for physiology-driven care is proposed, which has the potential to optimize care.

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Section: Framework To Optimize Therapymentioning

confidence: 99%

Haemodynamically unstable preterm infant: an unresolved management conundrum

Sehgal

2011

Eur J Pediatr

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“…1A). 6,12 Assessment of ECHO-PDA-hsPDA ECHO assessments were all made by a specialist pediatric cardiologist and a senior cardiology assistant. Two-dimensional ECHO analysis was performed to quantify ductal characteristics before deciding on ligation.…”

Section: Methodsmentioning

confidence: 99%

Which Inotropic Drug, Dobutamine or Milrinone, Is Clinically More Effective in the Treatment of Postligation Cardiac Syndrome in Preterm Infants?

et al. 2020

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Objective This study aimed to detect which of the two main medicines suggested in the treatment of postligation cardiac syndrome (PLCS)—dobutamine or mirinone—possesses a more therapeutic effect. While doing this, clinicians are provided with a broader perspective on the treatment and follow-up of cases. The desire was to increase the treatability and monitor ability of the cases in question and hence their survivability. Study Design A retrospective review of a cohort of infants with PLCS was conducted between March 2012 and December 2018. In the treatment of infants with PLCS, dobutamine (dobutamine study group-DSG) or milrinone (milrinone study group-MSG) was used. The respiration, cardiac, echocardiography, and perfusion parameters of the cases were assessed both before and after ligation. Based on the data obtained, both the effects of the medicines on PLCS and the difference between their therapeutic effects were studied. The accuracy of prognostication was assessed with receiver operating characteristic analyses. Results PLCS was detected in 29 (34.1%) of 85 patent ductus arteriosus ligation cases in total. Of all the PLCS cases, 13 (44.8%) were treated with dobutamine and 16 (55.2%) with milrinone. It was observed that the effects of the medicines on the respiratory system and cardiovascular system manifested in the third and 6th hour, respectively. It was detected that both medicines had more effect on the systolic blood pressure (SBP) (area under the curve [AUC]: 0.997/0.996, p = 0.001/0.002) than on the diastolic blood pressure (AUC: 0.911/0.843, p = 0.032/0.046). Conclusion Dobutamine and milrinone, two primary medicines that can be used in the treatment of cases with PLCS, possess similar therapeutic effects on this pathology. In addition, their postoperative therapeutic effects on the SBP are more in the foreground.

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“…(35) Cumulatively, milrinone increases cardiac output without an increase in myocardial oxygen demand while decreasing afterload by decreasing systemic vascular resistance. (32) The possible negative effects of milrinone include systemic hypotension, tachycardia, tachyarrhythmias, and thrombocytopenia. (31) Milrinone has primarily been investigated in infants for the prevention and treatment of low cardiac output after cardiac surgery.…”

Section: Adjuncts and Alternatives To Catecholamines Milrinonementioning

confidence: 99%

Inotrope and Vasopressor Support in Neonates

2015

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1. There is limited knowledge regarding the optimal management of neonates with hemodynamic instability. 2. One approach to hemodynamic instability may not be efficacious for all neonates. AbstractHemodynamic instability is a common problem in neonates and has important implications for long-term outcomes. Inotropes and vasopressors are commonly used to treat low blood pressure or poor perfusion in neonatal intensive care, despite limited evidence to guide optimal management in specific clinical situations. Dopamine is the most commonly used agent in clinical practice, increasing blood pressure with limited adverse effects compared with epinephrine. Dobutamine is less commonly used but may be the optimal agent for premature neonates with poor perfusion due to immature myocardial contractility. New evidence is emerging to guide the treatment of hypotension in the setting of sepsis and persistent pulmonary hypertension. Norepinephrine and vasopressin may have utility in the setting of refractory hypotension due to sepsis. Increasing evidence supports use of norepinephrine, milrinone, and vasopressin in the setting of persistent pulmonary hypertension. Hydrocortisone should be reserved for vasopressor-resistant hypotension in preterm neonates; however, this agent may also prove useful in the treatment of persistent pulmonary hypertension in term neonates. Further clinical trials are necessary to determine the optimal treatment algorithm for neonates with hemodynamic instability. Future trials should include physiologically relevant end points and long-term follow-up. However, one approach may not be efficacious for all neonates even with a similar diagnosis. Therefore, bedside assessment techniques should continue to be explored to allow tailored therapy based on real-time assessment of underlying physiology.Objectives After completing this article, readers should be able to:1. Characterize the mechanism of action, pharmacokinetic properties, and cardiovascular effects of different inotropes. 2. Describe additional medications that can provide cardiovascular support. 3. Determine clinical factors that affect medication selection.

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Use of milrinone in the management of haemodynamic instability following duct ligation

Cited by 23 publications

References 22 publications

Haemodynamically unstable preterm infant: an unresolved management conundrum

Haemodynamically unstable preterm infant: an unresolved management conundrum

Which Inotropic Drug, Dobutamine or Milrinone, Is Clinically More Effective in the Treatment of Postligation Cardiac Syndrome in Preterm Infants?

Inotrope and Vasopressor Support in Neonates

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