Milrinone, dobutamine or epinephrine use in asphyxiated newborn pigs resuscitated with 100% oxygen

Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
Intensive Care Medicine (Impact Factor: 7.21). 03/2010; 36(6):1058-66. DOI: 10.1007/s00134-010-1820-x
Source: PubMed


After resuscitation, asphyxiated neonates often develop poor cardiac function with hypotension, pulmonary hypertension and multiorgan ischemia. In a swine model of neonatal hypoxia-reoxygenation, effects of epinephrine, dobutamine and milrinone on systemic, pulmonary and regional hemodynamics and oxygen transport were compared.
Controlled, block-randomized study.
University research laboratory.
Mixed breed piglets (1-3 days, 1.5-2.3 kg).
In acutely instrumented piglets, normocapnic alveolar hypoxia (10-15% oxygen) was induced for 2 h followed by reoxygenation with 100% oxygen (1 h) then 21% oxygen (3 h). At 2 h of reoxygenation, after volume loading (Ringer's lactate 10 ml/kg), either saline (placebo), epinephrine (0.5 microg/kg/min), dobutamine (20 microg/kg/min) or milrinone (0.75 microg/kg/min) were infused for 2 h in a blinded, block-randomized fashion (n = 6/group).
All medications similarly improved cardiac output, stroke volume and systemic oxygen delivery (vs. placebo-controls, p < 0.05). Epinephrine and dobutamine significantly increased, while milrinone maintained, mean arterial pressure over pretreatment values while placebo-treated piglets developed hypotension and shock. The mean arterial to pulmonary arterial pressures ratio was not different among groups. All medications significantly increased carotid and intestinal, but not renal, arterial blood flows and oxygen delivery, whereas milrinone caused lower renal vascular resistance than epinephrine and dobutamine-treated groups. Plasma troponin I, plasma and myocardial lactate levels, and histologic ischemic features were not different among groups.
In newborn piglets with hypoxia-reoxygenation, epinephrine, dobutamine and milrinone are effective inotropes to improve cardiac output, carotid and intestinal perfusion, without aggravating pulmonary hypertension. Milrinone may also improve renal perfusion.

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    • "The existing information about the effects on cerebral perfusion and neurodevelopmental outcomes is clearly inadequate. Although there has been some research in this area, in neonatal animal models [5], [6], [8], [11], [12], which use mainly carotid blood flow measurements to study cerebral perfusion, the results are not consistent. This is probably due to the duration of treatment, the dose regimen and the existence of differences in measurement methods (NIRS, radiolabeled microspheres, electromagnetic flow probes, ultrasonic flow probes). "
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