Vasoactive Drugs and Hemodynamic Monitoring in Pediatric Cardiac Intensive Care

An Italian Survey

Alessandra Rizza, Elena Bignami, Alessandro Belletti, Angelo Polito, Zaccaria Ricci, Giuseppe Isgrò, A. Locatelli, Paola Cogo

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Little is known about practitioner preference, the availability of technology, and variability in practice with respect to hemodynamic monitoring and vasoactive drug use after congenital heart surgery. The aim of this study was to characterize current hospital practices related to the management of low cardiac output syndrome (LCOS) across Italy.

METHODS: We issued a 22-item questionnaire to 14 Italian hospitals performing pediatric cardiac surgery.

RESULTS: Electrocardiogram, invasive blood pressure, central venous pressure, pulse oximetry, diuresis, body temperature, arterial lactate, and blood gas analysis were identified as routine in hemodynamic monitoring. With regard to advanced hemodynamic monitoring, pulmonary arterial catheter and transpulmonary thermodilution were available in 43% of the centers, uncalibrated pulse contour methods in 29% of the centers, and transesophageal/transthoracic echocardiograms in all of the centers. Dopamine added to milrinone was the most frequent drug regimen for LCOS prevention after cardiopulmonary bypass. Overall, 86% of centers used milrinone alone as the initial treatment for LCOS with elevated systemic vascular resistances and levosimendan, the second preferred choice. In cases of LCOS with low vascular resistance, epinephrine was the first choice (10 centers), dopamine was the second choice (4 centers), followed by vasopressin and norepinephrine (3 centers). For treatment of LCOS with elevated pulmonary resistances, milrinone was the first choice (eight centers), followed by inhaled nitric oxide (five centers).

CONCLUSIONS: The survey shows that advanced hemodynamic monitoring is rarely performed. The most commonly used vasoactive drugs are milrinone, levosimendan, dopamine, epinephrine, vasopressin, and norepinephrine. Guidelines on the topic are warranted.

Original languageEnglish
Pages (from-to)25-31
Number of pages7
JournalWorld Journal for Pediatric and Congenital Hearth Surgery
Volume7
Issue number1
DOIs
Publication statusPublished - Jan 1 2016

Fingerprint

Low Cardiac Output
Drug Monitoring
Milrinone
Critical Care
Hemodynamics
Pediatrics
Dopamine
Vasopressins
Vascular Resistance
Epinephrine
Thoracic Surgery
Norepinephrine
Thermodilution
Lung
Blood Gas Analysis
Central Venous Pressure
Pediatric Hospitals
Oximetry
Diuresis
Body Temperature

Keywords

  • cardiopulmonary bypass
  • circulatory hemodynamics
  • congenital heart disease
  • inflammatory response
  • intensive care

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Vasoactive Drugs and Hemodynamic Monitoring in Pediatric Cardiac Intensive Care : An Italian Survey. / Rizza, Alessandra; Bignami, Elena; Belletti, Alessandro; Polito, Angelo; Ricci, Zaccaria; Isgrò, Giuseppe; Locatelli, A.; Cogo, Paola.

In: World Journal for Pediatric and Congenital Hearth Surgery, Vol. 7, No. 1, 01.01.2016, p. 25-31.

Research output: Contribution to journalArticle

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