Gebhard Caroline Eva, Desjardins Georges, Gebhard Cathérine, Gavra Paul, Denault André Y
Department of Anesthesiology and Critical Care, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
Department of Pharmacology, Université de Montréal, Montreal, Quebec, Canada.
J Cardiothorac Vasc Anesth. 2017 Apr;31(2):489-496. doi: 10.1053/j.jvca.2016.11.033. Epub 2016 Nov 22.
To evaluate intratracheal milrinone (tMil) administration for rapid treatment of right ventricular (RV) dysfunction as a novel route after cardiopulmonary bypass.
Retrospective analysis.
Single-center study.
The study comprised 7 patients undergoing cardiac surgery who exhibited acute RV dysfunction after cardiopulmonary bypass.
After difficult weaning caused by cardiopulmonary bypass-induced acute RV dysfunction, milrinone was administered as a 5-mg bolus inside the endotracheal tube.
RV function improvement, as indicated by decreasing pulmonary artery pressure and changes of RV waveforms, was observed in all 7 patients. Adverse effects of tMil included dynamic RV outflow tract obstruction (2 patients) and a decrease in systemic mean arterial pressure (1 patient).
tMil may be an effective, rapid, and easily applicable therapeutic alternative to inhaled milrinone for the treatment of acute RV failure during cardiac surgery. However, sufficiently powered clinical trials are needed to confirm these findings.
评估气管内给予米力农（tMil）作为体外循环后一种新途径快速治疗右心室（RV）功能障碍的效果。
回顾性分析。
单中心研究。
该研究纳入了7例接受心脏手术且在体外循环后出现急性RV功能障碍的患者。
在体外循环诱导的急性RV功能障碍导致脱机困难后，将5毫克米力农作为大剂量推注经气管内导管给药。
所有7例患者均观察到RV功能改善，表现为肺动脉压降低和RV波形变化。tMil的不良反应包括动态RV流出道梗阻（2例患者）和体循环平均动脉压降低（1例患者）。
tMil可能是治疗心脏手术期间急性RV衰竭的一种有效、快速且易于应用的治疗选择，可替代吸入用米力农。然而，需要有足够样本量的临床试验来证实这些发现。
