Inotropic support in cardiogenic shock: who leads the battle, milrinone or dobutamine?

Lozada-Martínez, Iván David; Bayona-Gamboa, Andrea Juliana; Meza-Fandiño, Duvier Fabián; Paz-Echeverry, Omar Andrés; Ávila-Bonilla, Ángela María; Paz-Echeverry, Mario Javier; Pineda-Trujillo, Frank Jaider; Rodríguez-García, Gina Paola; Covaleda-Vargas, Jaime Enrique; Narvaez‐Rojas, Alexis Rafael

doi:10.1016/j.amsu.2022.104763

Cited by 2 publications

(3 citation statements)

References 44 publications

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“…Milrinone is a phosphodiesterase type III inhibitor that acts on the myocardium by increasing intracellular cyclic AMP and calcium concentrations via inhibition of cAMP degradation [51,73,135]. It exerts positive inotropic and lusitropic effects on myocardium while decreasing systemic and pulmonary vascular resistance [136].…”

Section: Milrinonementioning

confidence: 99%

“…The vasodilatory activity is not affected by beta-blockers since it is not directly beta-1-receptor-mediated [137,138]. These properties make MIL a medication of choice for patients with low cardiac output and increased peripheral resistance and in neonates with PPHN [73,[139][140][141]. However, the risk of severe hypotension should be always considered [73,74,142].…”

Section: Milrinonementioning

confidence: 99%

“…The risk of hypotension is increased in the presence of certain neonatal morbidities, including very low GA, organ dysfunction, and perinatal asphyxia [30]. Therefore, it has been suggested that MIL must be administered cautiously, potentially combined with other inotropes to retain hemodynamic stability [73,74,142,147].…”

Section: Indications For Anti-hypotensive Medications In Clinical Pra...mentioning

confidence: 99%

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An Update on Pharmacologic Management of Neonatal Hypotension: When, Why, and Which Medication

Agakidou,

Chatziioannidis,

Kontou

et al. 2024

Children

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Anti-hypotensive treatment, which includes dopamine, dobutamine, epinephrine, norepinephrine, milrinone, vasopressin, terlipressin, levosimendan, and glucocorticoids, is a long-established intervention in neonates with arterial hypotension (AH). However, there are still gaps in knowledge and issues that need clarification. The main questions and challenges that neonatologists face relate to the reference ranges of arterial blood pressure in presumably healthy neonates in relation to gestational and postnatal age; the arterial blood pressure level that potentially affects perfusion of critical organs; the incorporation of targeted echocardiography and near-infrared spectroscopy for assessing heart function and cerebral perfusion in clinical practice; the indication, timing, and choice of medication for each individual patient; the limited randomized clinical trials in neonates with sometimes conflicting results; and the sparse data regarding the potential effect of early hypotension or anti-hypotensive medications on long-term neurodevelopment. In this review, after a short review of AH definitions used in neonates and existing data on pathophysiology of AH, we discuss currently available data on pharmacokinetic and hemodynamic effects, as well as the effectiveness and safety of anti-hypotensive medications in neonates. In addition, data on the comparisons between anti-hypotensive medications and current suggestions for the main indications of each medication are discussed.

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Section: Milrinonementioning

confidence: 99%

Section: Milrinonementioning

confidence: 99%

Section: Indications For Anti-hypotensive Medications In Clinical Pra...mentioning

confidence: 99%

See 1 more Smart Citation

An Update on Pharmacologic Management of Neonatal Hypotension: When, Why, and Which Medication

Agakidou,

Chatziioannidis,

Kontou

et al. 2024

Children

View full text Add to dashboard Cite

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Pharmacotherapy of acute ST-elevation myocardial infarction and the pharmacist’s role, part 2: Complications, postrevascularization care, and quality improvement

Hyland,

Max,

Eaton

et al. 2024

American Journal of Health-System Pharmacy

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Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Key pharmacotherapeutic modalities and considerations for the patient with ST-elevation myocardial infarction (STEMI) across the later phases of inpatient care are reviewed. Summary Published descriptions and validation of clinical pharmacist roles specific to the acute management of STEMI are limited. This high-risk period from presentation through revascularization, stabilization, and hospital discharge involves complex pharmacotherapeutic decision points, many operational medication needs, and multiple layers of quality oversight. A companion article reviewed STEMI pharmacotherapy from emergency department presentation through revascularization. Herein we complete the pharmacotherapy review for the STEMI patient across the inpatient phases of care, including the management of peri-infarction complications with vasoactive and antiarrhythmic agents, considerations for postrevascularization antithrombotics, and assessments of supportive therapies and secondary prevention. Key guideline recommendations and literature developments are summarized from the clinical pharmacist’s perspective alongside suggested pharmacist roles and responsibilities. Considerations for successful hospital discharge after STEMI and pharmacist involvement in associated institutional quality improvement efforts are also provided. We aim to support inpatient pharmacy departments in advancing clinical services for this critical patient population and call for further research delineating pharmacists’ impact on patient and institutional STEMI outcomes.

show abstract

Inotropic support in cardiogenic shock: who leads the battle, milrinone or dobutamine?

Cited by 2 publications

References 44 publications

An Update on Pharmacologic Management of Neonatal Hypotension: When, Why, and Which Medication

An Update on Pharmacologic Management of Neonatal Hypotension: When, Why, and Which Medication

Pharmacotherapy of acute ST-elevation myocardial infarction and the pharmacist’s role, part 2: Complications, postrevascularization care, and quality improvement

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