Pharmacokinetics and Pharmacodynamics of Nebulized and Intratracheal Milrinone in a Swine Model of Hypercapnia Pulmonary Hypertension

Reversal of Acute Right Ventricular Failure Early Post Left Ventricular Assist Device Placement by Intratracheal Milrinone Administration

“…3,5 In a recent animal porcine model, a favorable positive hemodynamic effect with reduction of the right-sided chamber dilatation was observed with intratracheal milrinone administration. 4 In our case, intratracheal milrinone was administered in a patient with LVAD with acute RVF and without preexisting pulmonary hypertension. We demonstrated that intratracheal milrinone administration has the potential to improve acute RVF because of its positive effect on right ventricle contractility and pulmonary vasculature in the absence of significant systemic vasodilatation (Discussion Video).…”

“…Instillation of milrinone directly into the endotracheal tube has been reported previously in cardiac surgical patients and represents a rapid method of milrinone administration. [3][4][5]…”

Intratracheal Milrinone for Acute Right Heart Dysfunction: Another Tool in the Pocket

“…8 Besides, available experimental evidence did not reveal any harm. 9 However, even if more than 60% of patients responded to intratracheal milrinone and did not need additional inotropes, a second pump run, or even mechanical support, those who did not had an unfavorable clinical course and a substantially higher mortality. It is of note that upon logistic regression, this subset of patients may be identified by having severely reduced left ventricular function, undergoing prolonged CPB duration, and experiencing a more positive fluid balance, 6 factors that easily may be determined before trying to go off pump.…”

Intrapulmonary Milrinone for Cardiac Surgery Provides Insight Into Precision Delivery of Aerosolized Vasodilators

“…In this edition of the Journal of Cardiothoracic and Vascular Anesthesia, Gavra et al performed an open-label pharmacokinetic and pharmacodynamic cohort study of 12 swine undergoing iMil administration through simple jet nebulization, vibrating mesh nebulization, intratracheal instillation, or intratracheal atomization using a hypercapneainduced PH model. 2 Mean arterial pressure to mean pulmonary arterial pressure (mAP:mPAP) ratios and right heart hemodynamics with echocardiographic parameters were measured in an effort to capture observed responses to the iMil. In addition, maximum plasma and urine concentrations were recorded as part of the pharmacokinetic/pharmacodynamic aim, which highlights the fact that iMil may partly deliver hemodynamic effects through systemic absorption.…”