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Kimberly Dow - One of the best experts on this subject based on the ideXlab platform.
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Inotrope use among extremely preterm infants in canadian neonatal intensive care units variation and outcomes
American Journal of Perinatology, 2014Co-Authors: Jonathan Wong, Prakesh S Shah, Eugene W Yoon, Wendy Yee, Shoo K Lee, Kimberly DowAbstract:OBJECTIVE To compare neonatal outcomes between infants who received Inotropes and those who did not, and identify variation in Inotrope use. STUDY DESIGN Retrospective review of data from neonates < 29 weeks gestation collected by the Canadian Neonatal Network during 2003 to 2010. After controlling for confounders and maternal/infant characteristics, rates of mortality and major morbidity were compared between those who received Inotropes on days 1 and 3 of admission and those who did not. Rate of Inotrope use was compared between sites. RESULTS Inotropes were administered to 772 (10%) of the 7,913 neonates. Infants who received Inotropes had significantly higher illness severity, surfactant use, and need for mechanical ventilation. Inotrope use was also associated with significantly higher rates of mortality (adjusted odds ratio [AOR] = 2.05 [1.64, 2.57]), retinopathy of prematurity (AOR = 2.04 [1.54, 2.71]), intraventricular hemorrhage (AOR = 1.59 [1.29, 1.93]), bronchopulmonary dysplasia (AOR = 1.38 [1.11, 1.72]), and necrotizing enterocolitis (AOR = 2.06 [1.59, 2.67]). Rates of Inotrope use varied significantly between participating sites (0-36%; AOR = 0 [0, 0.1]-7.7 [2.9, 21]). CONCLUSION Risk of mortality and major morbidities were significantly higher in neonates who received Inotropes. Inotrope use varied significantly among Canadian neonatal intensive care units.
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Inotrope use among extremely preterm infants in Canadian neonatal intensive care units: variation and outcomes.
American journal of perinatology, 2014Co-Authors: Jonathan Wong, Prakesh S Shah, Eugene W Yoon, Wendy Yee, Shoo Lee, Kimberly DowAbstract:To compare neonatal outcomes between infants who received Inotropes and those who did not, and identify variation in Inotrope use. Retrospective review of data from neonates < 29 weeks gestation collected by the Canadian Neonatal Network during 2003 to 2010. After controlling for confounders and maternal/infant characteristics, rates of mortality and major morbidity were compared between those who received Inotropes on days 1 and 3 of admission and those who did not. Rate of Inotrope use was compared between sites. Inotropes were administered to 772 (10%) of the 7,913 neonates. Infants who received Inotropes had significantly higher illness severity, surfactant use, and need for mechanical ventilation. Inotrope use was also associated with significantly higher rates of mortality (adjusted odds ratio [AOR] = 2.05 [1.64, 2.57]), retinopathy of prematurity (AOR = 2.04 [1.54, 2.71]), intraventricular hemorrhage (AOR = 1.59 [1.29, 1.93]), bronchopulmonary dysplasia (AOR = 1.38 [1.11, 1.72]), and necrotizing enterocolitis (AOR = 2.06 [1.59, 2.67]). Rates of Inotrope use varied significantly between participating sites (0-36%; AOR = 0 [0, 0.1]-7.7 [2.9, 21]). Risk of mortality and major morbidities were significantly higher in neonates who received Inotropes. Inotrope use varied significantly among Canadian neonatal intensive care units. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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Inotrope use among extremely preterm infants in Canadian neonatal intensive care units: variation and outcomes.
American Journal of Perinatology, 2014Co-Authors: Jonathan Wong, Prakesh S Shah, Eugene W Yoon, Wendy Yee, Shoo K Lee, Kimberly DowAbstract:OBJECTIVE To compare neonatal outcomes between infants who received Inotropes and those who did not, and identify variation in Inotrope use. STUDY DESIGN Retrospective review of data from neonates
Jonathan Wong - One of the best experts on this subject based on the ideXlab platform.
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Inotrope use among extremely preterm infants in canadian neonatal intensive care units variation and outcomes
American Journal of Perinatology, 2014Co-Authors: Jonathan Wong, Prakesh S Shah, Eugene W Yoon, Wendy Yee, Shoo K Lee, Kimberly DowAbstract:OBJECTIVE To compare neonatal outcomes between infants who received Inotropes and those who did not, and identify variation in Inotrope use. STUDY DESIGN Retrospective review of data from neonates < 29 weeks gestation collected by the Canadian Neonatal Network during 2003 to 2010. After controlling for confounders and maternal/infant characteristics, rates of mortality and major morbidity were compared between those who received Inotropes on days 1 and 3 of admission and those who did not. Rate of Inotrope use was compared between sites. RESULTS Inotropes were administered to 772 (10%) of the 7,913 neonates. Infants who received Inotropes had significantly higher illness severity, surfactant use, and need for mechanical ventilation. Inotrope use was also associated with significantly higher rates of mortality (adjusted odds ratio [AOR] = 2.05 [1.64, 2.57]), retinopathy of prematurity (AOR = 2.04 [1.54, 2.71]), intraventricular hemorrhage (AOR = 1.59 [1.29, 1.93]), bronchopulmonary dysplasia (AOR = 1.38 [1.11, 1.72]), and necrotizing enterocolitis (AOR = 2.06 [1.59, 2.67]). Rates of Inotrope use varied significantly between participating sites (0-36%; AOR = 0 [0, 0.1]-7.7 [2.9, 21]). CONCLUSION Risk of mortality and major morbidities were significantly higher in neonates who received Inotropes. Inotrope use varied significantly among Canadian neonatal intensive care units.
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Inotrope use among extremely preterm infants in Canadian neonatal intensive care units: variation and outcomes.
American journal of perinatology, 2014Co-Authors: Jonathan Wong, Prakesh S Shah, Eugene W Yoon, Wendy Yee, Shoo Lee, Kimberly DowAbstract:To compare neonatal outcomes between infants who received Inotropes and those who did not, and identify variation in Inotrope use. Retrospective review of data from neonates < 29 weeks gestation collected by the Canadian Neonatal Network during 2003 to 2010. After controlling for confounders and maternal/infant characteristics, rates of mortality and major morbidity were compared between those who received Inotropes on days 1 and 3 of admission and those who did not. Rate of Inotrope use was compared between sites. Inotropes were administered to 772 (10%) of the 7,913 neonates. Infants who received Inotropes had significantly higher illness severity, surfactant use, and need for mechanical ventilation. Inotrope use was also associated with significantly higher rates of mortality (adjusted odds ratio [AOR] = 2.05 [1.64, 2.57]), retinopathy of prematurity (AOR = 2.04 [1.54, 2.71]), intraventricular hemorrhage (AOR = 1.59 [1.29, 1.93]), bronchopulmonary dysplasia (AOR = 1.38 [1.11, 1.72]), and necrotizing enterocolitis (AOR = 2.06 [1.59, 2.67]). Rates of Inotrope use varied significantly between participating sites (0-36%; AOR = 0 [0, 0.1]-7.7 [2.9, 21]). Risk of mortality and major morbidities were significantly higher in neonates who received Inotropes. Inotrope use varied significantly among Canadian neonatal intensive care units. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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Inotrope use among extremely preterm infants in Canadian neonatal intensive care units: variation and outcomes.
American Journal of Perinatology, 2014Co-Authors: Jonathan Wong, Prakesh S Shah, Eugene W Yoon, Wendy Yee, Shoo K Lee, Kimberly DowAbstract:OBJECTIVE To compare neonatal outcomes between infants who received Inotropes and those who did not, and identify variation in Inotrope use. STUDY DESIGN Retrospective review of data from neonates
Randall C. Starling - One of the best experts on this subject based on the ideXlab platform.
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Inotropic Therapy for End-Stage Heart Failure Patients
Current Treatment Options in Cardiovascular Medicine, 2010Co-Authors: Mustafa Toma, Randall C. StarlingAbstract:Positive inotropic agents play an important role in the management of acute decompensated heart failure (HF) patients with reduced cardiac output and poor end-organ perfusion. However, despite their acute hemodynamic benefits, the role of Inotropes in the management of chronic advanced HF remains limited. Although digoxin has demonstrated the ability to improve symptoms in HF patients, numerous small, mostly nonrandomized studies have shown that patients with advanced HF improve symptomatically when administered continuous or intermittent intravenous β-agonists or phosphodiesterase inhibitors. However, this improvement occurs at the expense of an increased risk of cardiac arrhythmias, sudden cardiac death, and mortality. Similarly, several oral Inotropes have been developed and studied in larger randomized clinical trials. The PROMISE study found that oral milrinone is associated with increased mortality, whereas the ESSENTIAL study showed that oral enoximone does not result in any significant improvement in symptoms, exercise capacity, or survival. The calcium-sensitizing Inotrope levosimendan has shown some promise in the management of acute HF patients, but the PERSIST trial showed no improvement in survival or hospitalization rates with chronic oral therapy. This agent is still under investigation and is not available in the United States. Istaroxime, an Inotrope with lusitropic properties, is also being investigated for its potential use in advanced HF patients. The current American College of Cardiology/American Heart Association, European Society of Cardiology, and Heart Failure Society of America guidelines indicate that, other than digoxin, inotropic agents should be reserved for patients presenting with acute decompensated HF and low-output states and reduced end-organ perfusion, who typically are admitted to an intensive care unit. These agents also are of benefit in advanced HF patients as a bridge to transplantation to optimize end-organ function and may be used in the outpatient setting, usually in patients with an implantable cardioverter–defibrillator. Finally, Inotropes should be used to palliate symptoms in end-stage HF patients who have severe symptoms and are not candidates for heart transplantation or mechanical circulatory support.
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prognosis on chronic dobutamine or milrinone infusions for stage d heart failure
Circulation-heart Failure, 2009Co-Authors: Eiran Z Gorodeski, Jennifer Reese, Mehdi H Shishehbor, Eileen Hsich, Randall C. StarlingAbstract:Background— There are no published clinical trials comparing dobutamine with milrinone in outpatients with stage D heart failure on continuous Inotropes. Methods and Results— In a retrospective analysis of 112 Inotrope-dependent patients with stage D heart failure who were not transplant candidates at enrollment, we investigated the relationship between choice of dobutamine or milrinone and mortality. Half the patients were on dobutamine (mean dose, 5.4�2.5 μg/kg per minute) and half on milrinone (mean dose, 0.4�0.2 μg/kg per minute). Those on dobutamine tended to be older (63 years old versus 54 years old), male (86% versus 79%), and fewer had implantable cardioverter-defibrillators (57% versus 74%). During a median follow-up time of 130 days (range, 2 to 2345 days), there were 85 deaths (76% of cohort) and 55 rehospitalizations. Use of dobutamine compared with milrinone was associated with higher all-cause mortality in an unadjusted analysis (hazard ratio [HR], 1.63; 95% CI, 1.06 to 2.52; P<0.03). Howev...
Wendy Yee - One of the best experts on this subject based on the ideXlab platform.
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Inotrope use among extremely preterm infants in canadian neonatal intensive care units variation and outcomes
American Journal of Perinatology, 2014Co-Authors: Jonathan Wong, Prakesh S Shah, Eugene W Yoon, Wendy Yee, Shoo K Lee, Kimberly DowAbstract:OBJECTIVE To compare neonatal outcomes between infants who received Inotropes and those who did not, and identify variation in Inotrope use. STUDY DESIGN Retrospective review of data from neonates < 29 weeks gestation collected by the Canadian Neonatal Network during 2003 to 2010. After controlling for confounders and maternal/infant characteristics, rates of mortality and major morbidity were compared between those who received Inotropes on days 1 and 3 of admission and those who did not. Rate of Inotrope use was compared between sites. RESULTS Inotropes were administered to 772 (10%) of the 7,913 neonates. Infants who received Inotropes had significantly higher illness severity, surfactant use, and need for mechanical ventilation. Inotrope use was also associated with significantly higher rates of mortality (adjusted odds ratio [AOR] = 2.05 [1.64, 2.57]), retinopathy of prematurity (AOR = 2.04 [1.54, 2.71]), intraventricular hemorrhage (AOR = 1.59 [1.29, 1.93]), bronchopulmonary dysplasia (AOR = 1.38 [1.11, 1.72]), and necrotizing enterocolitis (AOR = 2.06 [1.59, 2.67]). Rates of Inotrope use varied significantly between participating sites (0-36%; AOR = 0 [0, 0.1]-7.7 [2.9, 21]). CONCLUSION Risk of mortality and major morbidities were significantly higher in neonates who received Inotropes. Inotrope use varied significantly among Canadian neonatal intensive care units.
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Inotrope use among extremely preterm infants in Canadian neonatal intensive care units: variation and outcomes.
American journal of perinatology, 2014Co-Authors: Jonathan Wong, Prakesh S Shah, Eugene W Yoon, Wendy Yee, Shoo Lee, Kimberly DowAbstract:To compare neonatal outcomes between infants who received Inotropes and those who did not, and identify variation in Inotrope use. Retrospective review of data from neonates < 29 weeks gestation collected by the Canadian Neonatal Network during 2003 to 2010. After controlling for confounders and maternal/infant characteristics, rates of mortality and major morbidity were compared between those who received Inotropes on days 1 and 3 of admission and those who did not. Rate of Inotrope use was compared between sites. Inotropes were administered to 772 (10%) of the 7,913 neonates. Infants who received Inotropes had significantly higher illness severity, surfactant use, and need for mechanical ventilation. Inotrope use was also associated with significantly higher rates of mortality (adjusted odds ratio [AOR] = 2.05 [1.64, 2.57]), retinopathy of prematurity (AOR = 2.04 [1.54, 2.71]), intraventricular hemorrhage (AOR = 1.59 [1.29, 1.93]), bronchopulmonary dysplasia (AOR = 1.38 [1.11, 1.72]), and necrotizing enterocolitis (AOR = 2.06 [1.59, 2.67]). Rates of Inotrope use varied significantly between participating sites (0-36%; AOR = 0 [0, 0.1]-7.7 [2.9, 21]). Risk of mortality and major morbidities were significantly higher in neonates who received Inotropes. Inotrope use varied significantly among Canadian neonatal intensive care units. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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Inotrope use among extremely preterm infants in Canadian neonatal intensive care units: variation and outcomes.
American Journal of Perinatology, 2014Co-Authors: Jonathan Wong, Prakesh S Shah, Eugene W Yoon, Wendy Yee, Shoo K Lee, Kimberly DowAbstract:OBJECTIVE To compare neonatal outcomes between infants who received Inotropes and those who did not, and identify variation in Inotrope use. STUDY DESIGN Retrospective review of data from neonates
Prakesh S Shah - One of the best experts on this subject based on the ideXlab platform.
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Inotrope use among extremely preterm infants in canadian neonatal intensive care units variation and outcomes
American Journal of Perinatology, 2014Co-Authors: Jonathan Wong, Prakesh S Shah, Eugene W Yoon, Wendy Yee, Shoo K Lee, Kimberly DowAbstract:OBJECTIVE To compare neonatal outcomes between infants who received Inotropes and those who did not, and identify variation in Inotrope use. STUDY DESIGN Retrospective review of data from neonates < 29 weeks gestation collected by the Canadian Neonatal Network during 2003 to 2010. After controlling for confounders and maternal/infant characteristics, rates of mortality and major morbidity were compared between those who received Inotropes on days 1 and 3 of admission and those who did not. Rate of Inotrope use was compared between sites. RESULTS Inotropes were administered to 772 (10%) of the 7,913 neonates. Infants who received Inotropes had significantly higher illness severity, surfactant use, and need for mechanical ventilation. Inotrope use was also associated with significantly higher rates of mortality (adjusted odds ratio [AOR] = 2.05 [1.64, 2.57]), retinopathy of prematurity (AOR = 2.04 [1.54, 2.71]), intraventricular hemorrhage (AOR = 1.59 [1.29, 1.93]), bronchopulmonary dysplasia (AOR = 1.38 [1.11, 1.72]), and necrotizing enterocolitis (AOR = 2.06 [1.59, 2.67]). Rates of Inotrope use varied significantly between participating sites (0-36%; AOR = 0 [0, 0.1]-7.7 [2.9, 21]). CONCLUSION Risk of mortality and major morbidities were significantly higher in neonates who received Inotropes. Inotrope use varied significantly among Canadian neonatal intensive care units.
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Inotrope use among extremely preterm infants in Canadian neonatal intensive care units: variation and outcomes.
American journal of perinatology, 2014Co-Authors: Jonathan Wong, Prakesh S Shah, Eugene W Yoon, Wendy Yee, Shoo Lee, Kimberly DowAbstract:To compare neonatal outcomes between infants who received Inotropes and those who did not, and identify variation in Inotrope use. Retrospective review of data from neonates < 29 weeks gestation collected by the Canadian Neonatal Network during 2003 to 2010. After controlling for confounders and maternal/infant characteristics, rates of mortality and major morbidity were compared between those who received Inotropes on days 1 and 3 of admission and those who did not. Rate of Inotrope use was compared between sites. Inotropes were administered to 772 (10%) of the 7,913 neonates. Infants who received Inotropes had significantly higher illness severity, surfactant use, and need for mechanical ventilation. Inotrope use was also associated with significantly higher rates of mortality (adjusted odds ratio [AOR] = 2.05 [1.64, 2.57]), retinopathy of prematurity (AOR = 2.04 [1.54, 2.71]), intraventricular hemorrhage (AOR = 1.59 [1.29, 1.93]), bronchopulmonary dysplasia (AOR = 1.38 [1.11, 1.72]), and necrotizing enterocolitis (AOR = 2.06 [1.59, 2.67]). Rates of Inotrope use varied significantly between participating sites (0-36%; AOR = 0 [0, 0.1]-7.7 [2.9, 21]). Risk of mortality and major morbidities were significantly higher in neonates who received Inotropes. Inotrope use varied significantly among Canadian neonatal intensive care units. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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Inotrope use among extremely preterm infants in Canadian neonatal intensive care units: variation and outcomes.
American Journal of Perinatology, 2014Co-Authors: Jonathan Wong, Prakesh S Shah, Eugene W Yoon, Wendy Yee, Shoo K Lee, Kimberly DowAbstract:OBJECTIVE To compare neonatal outcomes between infants who received Inotropes and those who did not, and identify variation in Inotrope use. STUDY DESIGN Retrospective review of data from neonates