Cardiothoracic & vascular anesthesia
Pulmonary Vasodilator Response of Combined Inhaled Epoprostenol and Inhaled Milrinone in Cardiac Surgical Patients
Authors' conclusion
A positive pulmonary vasodilator response to treatment with a combination of iE&iM before initiation of CPB was observed in 77% of patients. Higher baseline SPAP was an independent predictor of pulmonary vasodilator response, while EuroSCORE II >6.5% was a predictor of nonresponse to treatment.
Study context
- Population
- Patients with pulmonary hypertension (PH) or right ventricular (RV) dysfunction undergoing on-pump cardiac surgery, Montreal Heart Institute, July 2013 to December 2018
- Participants
- 128 patients
- Exposure
- Responders vs Nonresponders
- Outcome
- Rate of positive pulmonary vasodilator response to iE&iM (increase of 20% in MAP/MPAP ratio)
Methodological detailsconsecutive patients, single-centre
- Consecutive patients
- Single-centre
Main finding
As reported in the abstract
Positive pulmonary vasodilator response
Responders to iE&iM treatment
77.3%
Observational data: associations, not effects.
Further findings
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| Predictor of response: baseline SPAPPredictor of pulmonary vasodilator response | 1.63 (1.24–2.16) | P = 0.0006 | |
| Predictor of nonresponse: EuroSCORE II >6.5%EuroSCORE II ≤6.5% vs EuroSCORE II >6.5% · EuroSCORE II >6.5% predictor of nonresponse | 5.19 (1.84–14.66) | P = 0.002 | |
| 0.050.21520Odds ratio (log scale) |
MPAP >30 mm Hg
P = 0.0237
Systolic pulmonary artery pressure (SPAP) >55 mm Hg
- Higher proportion of responders had SPAP >55 mm Hg (responders vs nonresponders; P = .0037)
- 17.2% vs 3.4%
Easier separation from cardiopulmonary bypass (CPB)
- Easier separation from CPB associated with response to iE&iM (P = .0181)
- 69.7% vs 58.6%
Very difficult separation from CPB
- Higher proportion of nonresponders had very difficult separation from CPB and required IV inotropes; easy separation more frequent in responders
IV inotropes after CPB
- Use of IV inotropes after CPB lower in responders (P = .0052)
- 8.1% vs 27.6%
Original publication
Pulmonary Vasodilator Response of Combined Inhaled Epoprostenol and Inhaled Milrinone in Cardiac Surgical Patients. Anesth Analg. Published 19 September 2022. doi:10.
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