Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul 21;12(3):e122994.
doi: 10.5812/aapm-122994. eCollection 2022 Jun.

Comparison of Nebulized Versus Intravenous Milrinone on Reducing Pulmonary Arterial Pressure in Patients with Pulmonary Hypertension Candidate for Open-cardiac Surgery: A Double-Blind Randomized Clinical Trial

Sara Jorairahmadi  1 , Fatemeh Javaherforooshzadeh  1 , Marziyeh Babazadeh  2   3 , Behnam Gholizadeh  4   3 , Nima Bakhtiari  3
Affiliations

Comparison of Nebulized Versus Intravenous Milrinone on Reducing Pulmonary Arterial Pressure in Patients with Pulmonary Hypertension Candidate for Open-cardiac Surgery: A Double-Blind Randomized Clinical Trial

Sara Jorairahmadi et al. Anesth Pain Med. .

Abstract

Background: Regardless of the cause, pulmonary hypertension can increase patient complications and mortality. This study compared the effect of nebulized versus intravenous (IV) milrinone on reducing pulmonary arterial pressure in patients with pulmonary hypertension candidates for open-cardiac surgery.

Methods: This double-blind, randomized clinical trial was performed on 32 patients undergoing elective on-pump cardiac surgery during January 2021-January 2022 in the Cardiac Operating Room of Golestan Hospital, Ahvaz, Iran. Patients were randomly divided into test groups nebulize milrinone (N = 16) and IV milrinone (N = 16). The medication was administered after the cross-clamp of the aorta opening. The outcome variables included hemodynamic data, cardiac output, cardiac index, stroke volume, mean arterial pressure (MAP), central venous pressure, mean pulmonary artery pressure (mPAP), systemic vascular resistance, pulmonary vascular resistance, MAP/mPAP ratio, time until extubation, duration of hospitalization in the Intensive Care Unit (ICU), and duration of hospital stay.

Results: In the nebulized group, MAP and MAP/mPAP were significantly higher than in the IV milrinone group (P = 0.09 and P < 0.0001, respectively). The time of extubation (P = 0.001), duration of hospitalization in the ICU (P = 0.009), and duration of hospital stay (P = 0.026) in the nebulized milrinone group were significantly shorter than in the IV milrinone group.

Conclusions: Nebulized milrinone administration before weaning off cardiopulmonary bypass (CPB) can be accelerated and facilitate weaning off CPB. Moreover, despite maintaining MAP, nebulized milrinone significantly reduces mPAP. According to the results of this study, nebulized milrinone is recommended in patients undergoing cardiac surgery with pulmonary hypertension.

Keywords: Cardiopulmonary Bypass; Congenital Heart Disease; Milrinone; Pulmonary Hypertension; Valvular Heart Disease.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interests: The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.. Consort flow diagram
Figure 2.
Figure 2.. Comparison of the nebulized and IV groups for SBP and PVR at T2, T3, and T4. An SBP is smaller at T2, T3, and T4 in the IV group. B, PVR is higher at T2 and T4 in the nebulized group. *: P < 0.05, **: P < 0.01, and ****: P < 0.0001 were considered significant versus control.
Figure 3.
Figure 3.. Comparison of the ICU and hospital stay duration (A) and extubation time (B). A, ICU stay (P = 0.009), Hospital stays (P = 0.026), and B, extubation after ICU admission (P = 0.001), and has more time in the IV group. *: P < 0.05 and **: P < 0.01 were considered significant versus control.
See this image and copyright information in PMC

References

    1. Magne J, Pibarot P, Sengupta PP, Donal E, Rosenhek R, Lancellotti P. Pulmonary hypertension in valvular disease: a comprehensive review on pathophysiology to therapy from the HAVEC Group. JACC Cardiovasc Imaging. 2015;8(1):83–99. doi: 10.1016/j.jcmg.2014.12.003. - DOI - PubMed
    1. Guazzi M, Naeije R. Pulmonary Hypertension in Heart Failure: Pathophysiology, Pathobiology, and Emerging Clinical Perspectives. J Am Coll Cardiol. 2017;69(13):1718–34. doi: 10.1016/j.jacc.2017.01.051. - DOI - PubMed
    1. Sysol JR, Machado RF. Classification and pathophysiology of pulmonary hypertension. Contin Cardiol Educ. 2018;4(1):2–12. doi: 10.1002/cce2.71. - DOI
    1. Cheng JW, Tonelli AR, Pettersson G, Krasuski RA. Pharmacologic management of perioperative pulmonary hypertension. J Cardiovasc Pharmacol. 2014;63(4):375–84. doi: 10.1097/FJC.0000000000000050. - DOI - PMC - PubMed
    1. Denault A, Deschamps A, Tardif JC, Lambert J, Perrault L. Pulmonary hypertension in cardiac surgery. Curr Cardiol Rev. 2010;6(1):1–14. doi: 10.2174/157340310790231671. - DOI - PMC - PubMed

LinkOut - more resources