Department of Pharmacy, Stanford Children's Health, Palo Alto, CA.
Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, CA.
Pediatr Crit Care Med. 2020 Dec;21(12):e1134-e1139. doi: 10.1097/PCC.0000000000002562.
Limited data exist regarding the management of hypertension in pediatric patients on mechanical circulatory support. Hypertension is a known risk factor for stroke and low cardiac output in patients requiring mechanical circulatory support and a narrow therapeutic window of blood pressure is often targeted. Traditional short-acting infusions to treat hypertension, such as sodium nitroprusside, may lead to accumulation of toxic metabolites in patients with renal dysfunction. Our primary objective was to describe use of clevidipine, a continuous short-acting calcium channel blocking medication, for blood pressure control in pediatric patients on mechanical circulatory support.
Single-center retrospective cohort study.
A 26-bed quaternary cardiovascular ICU in a university-based pediatric hospital in California.
Mechanical circulatory support patients admitted to cardiovascular ICU who received clevidipine infusions between October 1, 2016, and March 31, 2019.
Clevidipine infusion.
Data from a cohort of 38 patients who received a total of 45 clevidipine infusions were reviewed. The cohort had a median age of 2.7 years and included neonates. No patient had record of hypotensive events, code events, or received low-dose epinephrine or code-dosed epinephrine related to a clevidipine infusion. Median duration of clevidipine infusion was 4.1 days (1.5-9.2 d). Eleven patients transitioned from clevidipine to enteral antihypertensive agents, and 26 clevidipine infusions were administered as a single agent without sodium nitroprusside. Seven patients were switched from sodium nitroprusside to clevidipine to avoid cyanide toxicity, a majority of whom had elevated serum creatinine.
In this pediatric cardiac cohort, clevidipine infusions were effective at hypertension management and were not associated with hypotensive or code events. This report details the largest cohort and longest duration of clevidipine administration within a pediatric population and did not demonstrate hypotensive events, even among neonatal populations. Clevidipine may be a reasonable cost-effective alternative antihypertensive medication compared to traditional short-acting agents.
关于接受机械循环支持的儿科患者的高血压管理，目前仅有有限的数据。高血压是机械循环支持患者发生中风和低心输出量的已知危险因素，且血压的治疗窗较窄。传统的用于治疗高血压的短效输注药物，如硝普钠，可能会导致肾功能不全患者积聚有毒代谢物。我们的主要目标是描述使用持续作用的短效钙通道阻滞剂药物盐酸拉贝洛尔（clevidipine）控制接受机械循环支持的儿科患者的血压。
单中心回顾性队列研究。
加利福尼亚州一所大学附属儿童医院的 26 张病床的四级心血管重症监护病房。
2016 年 10 月 1 日至 2019 年 3 月 31 日期间入住心血管重症监护病房并接受盐酸拉贝洛尔输注的机械循环支持患者。
盐酸拉贝洛尔输注。
共回顾了 38 例患者的 45 次盐酸拉贝洛尔输注的数据。该队列的中位年龄为 2.7 岁，包括新生儿。没有患者记录低血压事件、代码事件或接受与盐酸拉贝洛尔输注相关的低剂量肾上腺素或代码剂量肾上腺素。盐酸拉贝洛尔输注的中位持续时间为 4.1 天（1.5-9.2d）。11 例患者从盐酸拉贝洛尔转为肠内降压药物，26 例盐酸拉贝洛尔作为单一药物给药，未使用硝普钠。7 例患者从硝普钠转为盐酸拉贝洛尔以避免氰化物毒性，其中大多数患者的血清肌酐升高。
在这个儿科心脏队列中，盐酸拉贝洛尔输注有效地控制了高血压，并且与低血压或代码事件无关。本报告详细介绍了儿科人群中最大的盐酸拉贝洛尔使用队列和最长的持续时间，并且即使在新生儿人群中也未显示出低血压事件。与传统的短效药物相比，盐酸拉贝洛尔可能是一种合理的具有成本效益的降压药物替代药物。
