The Experts below are selected from a list of 273 Experts worldwide ranked by ideXlab platform
Christopher Commichau - One of the best experts on this subject based on the ideXlab platform.
-
Dobutamine versus Milrinone after subarachnoid hemorrhage.
Neurosurgery, 2015Co-Authors: Andrew M Naidech, Yunling Du, Kurt T Kreiter, Augusta Parra, Brianfred Fitzsimmons, Sean D Lavine, Stephan A Mayer, E. Sander Connolly, Christopher CommichauAbstract:OBJECTIVE: Neurogenic stunned myocardium is a well-recognized complication of subarachnoid hemorrhage. Dobutamine and Milrinone are both used for neurogenic stunned myocardium, but there are few data comparing them after subarachnoid hemorrhage. METHODS: We compared the physiological dose response of dobutamine and Milrinone in patients with subarachnoid hemorrhage requiring a pulmonary artery catheter. We located 11 patients who received either inotrope. Physiological data were fitted to a mixed model accounting for drug, dose, and between-patient variation. RESULTS: There were 11 patients who had 152 pulmonary artery catheter measurements. Two received both inotropes (but not within 4 h of each other), 2 only Milrinone, and 7 only dobutamine. The groups had similar clinical and physiological characteristics. After adjustment for vasopressin, Milrinone was significantly more potent in increasing cardiac output (P
-
dobutamine versus Milrinone after subarachnoid hemorrhage
Neurosurgery, 2005Co-Authors: Andrew M Naidech, Yunling Du, Kurt T Kreiter, Augusta Parra, Brianfred Fitzsimmons, Sean D Lavine, Sander E Connolly, Stephan A Mayer, Christopher CommichauAbstract:OBJECTIVE: Neurogenic stunned myocardium is a well-recognized complication of subarachnoid hemorrhage. Dobutamine and Milrinone are both used for neurogenic stunned myocardium, but there are few data comparing them after subarachnoid hemorrhage. METHODS: We compared the physiological dose response of dobutamine and Milrinone in patients with subarachnoid hemorrhage requiring a pulmonary artery catheter. We located 11 patients who received either inotrope. Physiological data were fitted to a mixed model accounting for drug, dose, and between-patient variation. RESULTS: There were 11 patients who had 152 pulmonary artery catheter measurements. Two received both inotropes (but not within 4 h of each other), 2 only Milrinone, and 7 only dobutamine. The groups had similar clinical and physiological characteristics. After adjustment for vasopressin, Milrinone was significantly more potent in increasing cardiac output (P <0.0001) and stroke volume (P=0.03), while decreasing vascular resistance (P <0.0001) and systolic blood pressure (P=0.008), than dobutamine. CONCLUSION: These data suggest that Milrinone and dobutamine should be used in different clinical situations. Milrinone may be more effective in patients with severely depressed systolic function but who have at least normal vascular resistance and blood pressure and in whom raising cardiac output is the primary goal. Dobutamine may be superior when vascular resistance or blood pressure is low.
Carljohan Jakobsen - One of the best experts on this subject based on the ideXlab platform.
-
intraoperative Milrinone versus dobutamine in cardiac surgery patients a retrospective cohort study on mortality
Critical Care, 2018Co-Authors: Dorthe Viemose Nielsen, Christian Torppedersen, Regitze Kuhr Skals, Thomas A Gerds, Zidryne Karaliunaite, Carljohan JakobsenAbstract:Several choices of inotropic therapy are available and used in relation to cardiac surgery. Comparisons are necessary to select optimal therapy. In Denmark, dobutamine and Milrinone are the two inotropic agents most commonly used to treat post-bypass low cardiac output syndrome. This study compares all-cause mortality with these drugs. In a retrospective observational study we investigated 10,700 consecutive patients undergoing cardiac surgery from 1 April 2006 to 31 December 2013 at Aarhus and Aalborg University Hospitals in the Central and Northern Denmark Region. Prospectively entered data in the Western Danish Heart Registry on intraoperative use of inotropes were used to identify 952 patients treated with Milrinone, 418 patients treated with dobutamine, and 82 patients receiving a combination of the two inotropes. All-cause mortality among patients receiving dobutamine was compared to all-cause mortality among Milrinone receivers. Multiple logistic regression analyses including preoperative and intraoperative variables along with g-formula analyses were used to model 30-day and 1-year mortality risks. Reported were standardized mortality risk differences between the treatment groups. Among patients receiving intraoperative dobutamine, 18 (4.3%) died within 30 days and 49 (11.7%) within 1 year. Corresponding 30-day and 1-year mortality for Milrinone receivers were 81 (8.5%) and 170 (17.9%). Risk of death within 30 days and 1 year was increased for intraoperative Milrinone compared to dobutamine with a standardized risk difference of 4.06% (confidence interval (CI) 1.23; 6.89, p = 0.005) and 4.77% (CI 0.39; 9.15, p = 0.033), respectively. Sensitivity analyses including adjustment for Milrinone preference, hemodynamic instability prior to cardiopulmonary bypass, and separate analyses on hospital level all confirmed a sign toward increased mortality among Milrinone receivers. Intraoperative use of Milrinone in cardiac surgery may be associated with an increase in all-cause mortality compared to use of dobutamine.
David A Osborn - One of the best experts on this subject based on the ideXlab platform.
-
randomized trial of Milrinone versus placebo for prevention of low systemic blood flow in very preterm infants
The Journal of Pediatrics, 2009Co-Authors: Mary Paradisis, Nick Evans, Martin Kluckow, David A OsbornAbstract:Objective To assess the effectiveness of early prophylactic Milrinone versus placebo for prevention of low systemic blood flow in high-risk preterm infants. Study design Double-blind randomized placebo controlled trial of Milrinone (loading dose 0.75 μg/kg/min for 3 hours then maintenance 0.2 μg/kg/min until 18 hours after birth) versus placebo. Infants born Results Ninety infants were enrolled, equal proportions maintained SVC flow ≥45 mL/kg/min after treatment commenced. No significant difference was observed in SVC flow, right ventricular output, and blood pressure during the first 24 hours; or grades 3 to 4 periventricular/intraventricular hemorrhage and death. Heart rate was higher and constriction of the ductus was slower in the infants randomized to Milrinone. Conclusions Milrinone did not prevent low systemic blood flow during the first 24 hours in very preterm infants, and no adverse effects were attributable to Milrinone. Use of a preventative treatment with rescue model allowed comparison of an inotrope with placebo in this high-risk group of infants.
-
population pharmacokinetics and dosing regimen design of Milrinone in preterm infants
Archives of Disease in Childhood-fetal and Neonatal Edition, 2007Co-Authors: Mary Paradisis, Xuemin Jiang, Andrew J Mclachlan, Nick Evans, Martin Kluckow, David A OsbornAbstract:Aims: To define the pharmacokinetics of Milrinone in very preterm infants and determine an optimal dose regimen to prevent low systemic blood flow in the first 12 h after birth. Methods: A prospective open-labelled, dose-escalation pharmacokinetic study was undertaken in two stages. In stage one, infants received Milrinone at 0.25 μg/kg/min (n = 8) and 0.5 μg/kg/min (n = 11) infused from 3 to 24 h of age. Infants contributed 4–5 blood samples for concentration–time data which were analysed using a population modelling approach. A simulation study was used to explore the optimal dosing regimen to achieve target Milrinone concentrations (180–300 ng/ml). This Milrinone regimen was evaluated in stage two (n = 10). Results: Infants (n = 29) born before 29 weeks gestation were enrolled. Milrinone pharmacokinetics were described using a one-compartment model with first-order elimination rate, with a population mean clearance (CV%) of 35 ml/h (24%) and volume of distribution of 512 ml (21%) and estimated half-life of 10 h. The 0.25 and 0.5 μg/kg/min dosage regimens did not achieve optimal Milrinone concentration-time profiles to prevent early low systemic blood flow. Simulation studies predicted a loading infusion (0.75 μg/kg/min for 3 h) followed by maintenance infusion (0.2 μg/kg/min until 18 h of age) would provide an optimal Milrinone concentration profile. This was confirmed in stage two of the study. Conclusion: Population pharmacokinetic modelling in the preterm infant has established an optimal dose regimen for Milrinone that increases the likelihood of achieving therapeutic aims and highlights the importance of pharmacokinetic studies in neonatal clinical pharmacology.
Mary Paradisis - One of the best experts on this subject based on the ideXlab platform.
-
randomized trial of Milrinone versus placebo for prevention of low systemic blood flow in very preterm infants
The Journal of Pediatrics, 2009Co-Authors: Mary Paradisis, Nick Evans, Martin Kluckow, David A OsbornAbstract:Objective To assess the effectiveness of early prophylactic Milrinone versus placebo for prevention of low systemic blood flow in high-risk preterm infants. Study design Double-blind randomized placebo controlled trial of Milrinone (loading dose 0.75 μg/kg/min for 3 hours then maintenance 0.2 μg/kg/min until 18 hours after birth) versus placebo. Infants born Results Ninety infants were enrolled, equal proportions maintained SVC flow ≥45 mL/kg/min after treatment commenced. No significant difference was observed in SVC flow, right ventricular output, and blood pressure during the first 24 hours; or grades 3 to 4 periventricular/intraventricular hemorrhage and death. Heart rate was higher and constriction of the ductus was slower in the infants randomized to Milrinone. Conclusions Milrinone did not prevent low systemic blood flow during the first 24 hours in very preterm infants, and no adverse effects were attributable to Milrinone. Use of a preventative treatment with rescue model allowed comparison of an inotrope with placebo in this high-risk group of infants.
-
population pharmacokinetics and dosing regimen design of Milrinone in preterm infants
Archives of Disease in Childhood-fetal and Neonatal Edition, 2007Co-Authors: Mary Paradisis, Xuemin Jiang, Andrew J Mclachlan, Nick Evans, Martin Kluckow, David A OsbornAbstract:Aims: To define the pharmacokinetics of Milrinone in very preterm infants and determine an optimal dose regimen to prevent low systemic blood flow in the first 12 h after birth. Methods: A prospective open-labelled, dose-escalation pharmacokinetic study was undertaken in two stages. In stage one, infants received Milrinone at 0.25 μg/kg/min (n = 8) and 0.5 μg/kg/min (n = 11) infused from 3 to 24 h of age. Infants contributed 4–5 blood samples for concentration–time data which were analysed using a population modelling approach. A simulation study was used to explore the optimal dosing regimen to achieve target Milrinone concentrations (180–300 ng/ml). This Milrinone regimen was evaluated in stage two (n = 10). Results: Infants (n = 29) born before 29 weeks gestation were enrolled. Milrinone pharmacokinetics were described using a one-compartment model with first-order elimination rate, with a population mean clearance (CV%) of 35 ml/h (24%) and volume of distribution of 512 ml (21%) and estimated half-life of 10 h. The 0.25 and 0.5 μg/kg/min dosage regimens did not achieve optimal Milrinone concentration-time profiles to prevent early low systemic blood flow. Simulation studies predicted a loading infusion (0.75 μg/kg/min for 3 h) followed by maintenance infusion (0.2 μg/kg/min until 18 h of age) would provide an optimal Milrinone concentration profile. This was confirmed in stage two of the study. Conclusion: Population pharmacokinetic modelling in the preterm infant has established an optimal dose regimen for Milrinone that increases the likelihood of achieving therapeutic aims and highlights the importance of pharmacokinetic studies in neonatal clinical pharmacology.
Andrew M Naidech - One of the best experts on this subject based on the ideXlab platform.
-
Dobutamine versus Milrinone after subarachnoid hemorrhage.
Neurosurgery, 2015Co-Authors: Andrew M Naidech, Yunling Du, Kurt T Kreiter, Augusta Parra, Brianfred Fitzsimmons, Sean D Lavine, Stephan A Mayer, E. Sander Connolly, Christopher CommichauAbstract:OBJECTIVE: Neurogenic stunned myocardium is a well-recognized complication of subarachnoid hemorrhage. Dobutamine and Milrinone are both used for neurogenic stunned myocardium, but there are few data comparing them after subarachnoid hemorrhage. METHODS: We compared the physiological dose response of dobutamine and Milrinone in patients with subarachnoid hemorrhage requiring a pulmonary artery catheter. We located 11 patients who received either inotrope. Physiological data were fitted to a mixed model accounting for drug, dose, and between-patient variation. RESULTS: There were 11 patients who had 152 pulmonary artery catheter measurements. Two received both inotropes (but not within 4 h of each other), 2 only Milrinone, and 7 only dobutamine. The groups had similar clinical and physiological characteristics. After adjustment for vasopressin, Milrinone was significantly more potent in increasing cardiac output (P
-
dobutamine versus Milrinone after subarachnoid hemorrhage
Neurosurgery, 2005Co-Authors: Andrew M Naidech, Yunling Du, Kurt T Kreiter, Augusta Parra, Brianfred Fitzsimmons, Sean D Lavine, Sander E Connolly, Stephan A Mayer, Christopher CommichauAbstract:OBJECTIVE: Neurogenic stunned myocardium is a well-recognized complication of subarachnoid hemorrhage. Dobutamine and Milrinone are both used for neurogenic stunned myocardium, but there are few data comparing them after subarachnoid hemorrhage. METHODS: We compared the physiological dose response of dobutamine and Milrinone in patients with subarachnoid hemorrhage requiring a pulmonary artery catheter. We located 11 patients who received either inotrope. Physiological data were fitted to a mixed model accounting for drug, dose, and between-patient variation. RESULTS: There were 11 patients who had 152 pulmonary artery catheter measurements. Two received both inotropes (but not within 4 h of each other), 2 only Milrinone, and 7 only dobutamine. The groups had similar clinical and physiological characteristics. After adjustment for vasopressin, Milrinone was significantly more potent in increasing cardiac output (P <0.0001) and stroke volume (P=0.03), while decreasing vascular resistance (P <0.0001) and systolic blood pressure (P=0.008), than dobutamine. CONCLUSION: These data suggest that Milrinone and dobutamine should be used in different clinical situations. Milrinone may be more effective in patients with severely depressed systolic function but who have at least normal vascular resistance and blood pressure and in whom raising cardiac output is the primary goal. Dobutamine may be superior when vascular resistance or blood pressure is low.