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• W2329915364 abstract "PurposeEvaluation of plasma inhaled versus intravenous Milrinone levels in advanced heart failure patients with RV dysfunction receiving Hearmate II LVAD. Milrinone is a PDE III inhibitor, intravenously administered resulting in pulmonary and systemic vasodilation, increased inotropy and lusitropy. Milrinone is renally excreted and plasma levels accumulate in advanced HF patients due to decrease in creatinine clearance resulting in hypotension even at low doses. Inhaled Milrinone plasma levels obtain same therapeutic effects without systemic hypotension and/or plasma accumulation.MethodsProspective, pilot study of 10 patients receiving inhaled Milrinone for 24 h post Heartmate II LVAD or until extubation, if less than 24 h. Inhaled Milrinone was started in OR upon wean from cardiopulmonary bypass and plasma levels were measured upon arrival to ICU (time 0),then at 1,4,8,12 and 24 h.This data was compared with literature plasma levels on patients with advanced heart failure receiving intravenous Milrinone.Creatinine clearance was less than 60 mg/dl in 7/10 patients.ResultsInhaled plasma Milrinone levels at the end of therapy ranged from 100.88 ng/ml to 349.39 ng/ml, with an average of 193 ng/ml and a median of 157.89 ng/ml.1/10 subject had PEA arrest not related to the drug and 3/10 patients had VT, without hemodynamic implications. There were no death or allergic reaction to Milrinone. Creatinine improved (p=0.2).Right atrial pressure as a marker of RV function improved (p=0.01).Literature plasma levels of intravenous Milrinone in advanced HF patients are reported of more than 300 ng/ml with concomitent worsening in creatinine due to hypotension and increased incidence of VT.ConclusionInhaled Milrinone in patients with RV dysfunction receiving LVAD has less side effects than intravenous Milrinone, while maintaining beneficial inotropy and pulmonary vasodilation due to lower therapeutic plasma levels. PurposeEvaluation of plasma inhaled versus intravenous Milrinone levels in advanced heart failure patients with RV dysfunction receiving Hearmate II LVAD. Milrinone is a PDE III inhibitor, intravenously administered resulting in pulmonary and systemic vasodilation, increased inotropy and lusitropy. Milrinone is renally excreted and plasma levels accumulate in advanced HF patients due to decrease in creatinine clearance resulting in hypotension even at low doses. Inhaled Milrinone plasma levels obtain same therapeutic effects without systemic hypotension and/or plasma accumulation. Evaluation of plasma inhaled versus intravenous Milrinone levels in advanced heart failure patients with RV dysfunction receiving Hearmate II LVAD. Milrinone is a PDE III inhibitor, intravenously administered resulting in pulmonary and systemic vasodilation, increased inotropy and lusitropy. Milrinone is renally excreted and plasma levels accumulate in advanced HF patients due to decrease in creatinine clearance resulting in hypotension even at low doses. Inhaled Milrinone plasma levels obtain same therapeutic effects without systemic hypotension and/or plasma accumulation. MethodsProspective, pilot study of 10 patients receiving inhaled Milrinone for 24 h post Heartmate II LVAD or until extubation, if less than 24 h. Inhaled Milrinone was started in OR upon wean from cardiopulmonary bypass and plasma levels were measured upon arrival to ICU (time 0),then at 1,4,8,12 and 24 h.This data was compared with literature plasma levels on patients with advanced heart failure receiving intravenous Milrinone.Creatinine clearance was less than 60 mg/dl in 7/10 patients. Prospective, pilot study of 10 patients receiving inhaled Milrinone for 24 h post Heartmate II LVAD or until extubation, if less than 24 h. Inhaled Milrinone was started in OR upon wean from cardiopulmonary bypass and plasma levels were measured upon arrival to ICU (time 0),then at 1,4,8,12 and 24 h.This data was compared with literature plasma levels on patients with advanced heart failure receiving intravenous Milrinone.Creatinine clearance was less than 60 mg/dl in 7/10 patients. ResultsInhaled plasma Milrinone levels at the end of therapy ranged from 100.88 ng/ml to 349.39 ng/ml, with an average of 193 ng/ml and a median of 157.89 ng/ml.1/10 subject had PEA arrest not related to the drug and 3/10 patients had VT, without hemodynamic implications. There were no death or allergic reaction to Milrinone. Creatinine improved (p=0.2).Right atrial pressure as a marker of RV function improved (p=0.01).Literature plasma levels of intravenous Milrinone in advanced HF patients are reported of more than 300 ng/ml with concomitent worsening in creatinine due to hypotension and increased incidence of VT. Inhaled plasma Milrinone levels at the end of therapy ranged from 100.88 ng/ml to 349.39 ng/ml, with an average of 193 ng/ml and a median of 157.89 ng/ml.1/10 subject had PEA arrest not related to the drug and 3/10 patients had VT, without hemodynamic implications. There were no death or allergic reaction to Milrinone. Creatinine improved (p=0.2).Right atrial pressure as a marker of RV function improved (p=0.01).Literature plasma levels of intravenous Milrinone in advanced HF patients are reported of more than 300 ng/ml with concomitent worsening in creatinine due to hypotension and increased incidence of VT. ConclusionInhaled Milrinone in patients with RV dysfunction receiving LVAD has less side effects than intravenous Milrinone, while maintaining beneficial inotropy and pulmonary vasodilation due to lower therapeutic plasma levels. Inhaled Milrinone in patients with RV dysfunction receiving LVAD has less side effects than intravenous Milrinone, while maintaining beneficial inotropy and pulmonary vasodilation due to lower therapeutic plasma levels." @default.
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• W2329915364 date "2014-04-01" @default.
• W2329915364 modified "2023-09-26" @default.
• W2329915364 title "Inhaled Milrinone Plasma Level Implications in Patients with RV Dysfunction Receiving Heartmate II LVAD" @default.
• W2329915364 doi "https://doi.org/10.1016/j.healun.2014.01.241" @default.
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