Increasing Mean Arterial Blood Pressure and Heart Rate With Catecholaminergic Drugs Does Not Improve the Microcirculation in Children With Congenital Diaphragmatic Hernia

Buijs, Erik; Kraemer, Ulrike; Andrinopoulou, Eleni‐Rosalina; Zwiers, Alexandra; İnce, Can; Tibboel, Dick

doi:10.1097/pcc.0000000000000105

Cited by 20 publications

(17 citation statements)

References 34 publications

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“…In a group of patients with diaphragmatic hernia increased heart rate was reported after dopamine treatment [23]. Similar effect was observed in preterm infants who received dopamine after administration of indomethacin [24] and in preterm infants with septic shock [25].…”

Section: Dosingsupporting

confidence: 51%

“…In a group of newborns with congenital diaphragmatic hernia, dopamine increased blood pressure with no effect on skin microcirculation and perfusion [23].…”

Section: Dosingmentioning

confidence: 99%

“…In a group of children including newborn infants NE has been shown to increase blood pressure on a dose dependent fashion [77]. One prospective cohort study has shown increased blood pressure with NE in newborns with congenital diaphragmatic hernia with no change in microcirculation measured by SDF imaging where peripheral microvascular bed is assessed [23]. In one observational study in term newborns with septic shock NE use has resulted in increase in blood pressure and urine output and decrease in lactate levels [78].…”

Section: Evidence and Pd Effectsmentioning

confidence: 99%

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Cardiovascular Drug Therapy for Human Newborn: Review of Pharmacodynamic Data

Ergenekon

Rojas-Anaya

Bravo

et al. 2018

CPD

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Background: Circulatory failure in preterm and term newborn infants is commonly treated with inotropes or vasoactive medications. In this structured literature review the available data on pharmacodynamic effects of the inotropes adrenaline, dobutamine, dopamine, levosimendan, milrinone, noradrenaline, and the vasoactive drugs vasopressin and hydrocortisone are presented. Methods: Structured searches were conducted to identify relevant articles according to pre-defined inclusion criteria which were human clinical trials published after 2000.Results: Out of 101 identified eligible studies only 22 studies met the criteria for evidence based practice guidelines level I to IV. The most prevalent pharmacodynamic effects were increase in blood pressure and/or heart rate, which were also the most frequently studied circulatory parameters. Conclusion: This review demonstrates the need for further systematic studies on all reviewed drugs with incorporation of novel noninvasive biomarkers in this vulnerable patient group, for more timely and appropriate treatment for clinical efficacy.

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Section: Dosingsupporting

confidence: 51%

“…In a group of newborns with congenital diaphragmatic hernia, dopamine increased blood pressure with no effect on skin microcirculation and perfusion [23].…”

Section: Dosingmentioning

confidence: 99%

Section: Evidence and Pd Effectsmentioning

confidence: 99%

See 1 more Smart Citation

Cardiovascular Drug Therapy for Human Newborn: Review of Pharmacodynamic Data

Ergenekon

Rojas-Anaya

Bravo

et al. 2018

CPD

View full text Add to dashboard Cite

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“…In preterm and term neonates, however, small vessels are, on average, 8.4 μm; moreover, in term neonates, the capillary diameter does not exceed 10 μm [47]. Thus, in pediatric studies, a general cutoff value of 10 μm is used [48, 49, 70–74]. Ideally, multiple measurements should be performed per organ in at least three different sites [69].…”

Section: Introductionmentioning

confidence: 99%

The vulnerable microcirculation in the critically ill pediatric patient

2016

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In neonates, cardiovascular system development does not stop after the transition from intra-uterine to extra-uterine life and is not limited to the macrocirculation. The microcirculation (MC), which is essential for oxygen, nutrient, and drug delivery to tissues and cells, also develops. Developmental changes in the microcirculatory structure continue to occur during the initial weeks of life in healthy neonates. The physiologic hallmarks of neonates and developing children make them particularly vulnerable during critical illness; however, the cardiovascular monitoring possibilities are limited compared with critically ill adult patients. Therefore, the development of non-invasive methods for monitoring the MC is necessary in pediatric critical care for early identification of impending deterioration and to enable the initiation and titration of therapy to ensure cell survival. To date, the MC may be non-invasively monitored at the bedside using hand-held videomicroscopy, which provides useful information regarding the microcirculation. There is an increasing number of studies on the MC in neonates and pediatric patients; however, additional steps are necessary to transition MC monitoring from bench to bedside. The recently introduced concept of hemodynamic coherence describes the relationship between changes in the MC and macrocirculation. The loss of hemodynamic coherence may result in a depressed MC despite an improvement in the macrocirculation, which represents a condition associated with adverse outcomes. In the pediatric intensive care unit, the concept of hemodynamic coherence may function as a framework to develop microcirculatory measurements towards implementation in daily clinical practice.

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“…In a small cohort study, dopamine, epinephrine and norepinephrine increased heart rate and mean arterial pressure without improving buccal perfusion (a proxy for the microcirculation). 31 Milrinone, a purported pulmonary vasodilator and inotrope, was shown to reduce both right ventricular dysfunction and oxygenation index substantially. 32 Reports of low cortisol levels, 33 as well as altered expression of corticotropin binding protein and its receptor, in neonates with pulmonary hypertension 34 suggest a specific role for hydrocortisone in infants with CDH who have refractory hypotension.…”

Section: B-nrmentioning

confidence: 99%