Preview

Does Milrinone Prevent Low Cardiac Output Syndrome in the Pediatric Population after Congenital Heart Surgery?

Powerful Essays
Open Document
Open Document
3212 Words
Grammar
Grammar
Plagiarism
Plagiarism
Writing
Writing
Score
Score
Does Milrinone Prevent Low Cardiac Output Syndrome in the Pediatric Population after Congenital Heart Surgery?
|The university of Auckland |
|Does Milrinone Prevent Low Cardiac Output Syndrome in the Paediatric Population after Congenital Heart surgery? |
|Nursing 730 (A&B) |
| |
|Paediatric Cardiac Nursing |
|Clinical Practice Review, Assessment 1. |

10th September 2010

Lecturer

|Word Count 2740 |

Congenital heart disease (CHD) accounts for a large portion of clinically significant birth defects, and remains the leading cause of infant deaths (M. Torres, Pharm, & Nieves, 2008). Advances in paediatric cardiology, cardiothoracic surgery and intensive care have dramatically improved survival for these children. However, even with this progress there remains to be an expected and reproducible fall in cardiac output, low cardiac output syndrome (LCOS), after cardiac surgery (Bailey et al., 2004; Ravishankar, Tabbutt, & Wernovsky, 2003; M. Torres, et al., 2008).

In the following assignment I will be reviewing the evidence relating to the use of milrinone, a phosphodiesterase inhibitor that is commonly used to increase cardiac output in children after cardiac surgery. I will focus on LCOS in children and the pathophysiology surrounding this. I will also examine the biological action of milrinone and how it has been shown to increase cardiac output in children after



References: Costa Auler Jr, J. O., Costa Barreto, A., Gimenez, S. O., & Abellan, D. M. (2002). Pediatric Cardiac Postoperative Care. Rev.Hosp.Clin.Fac.Med.S.Paulo, 57(3), 115-123. Duggal, B., Pratap, U., Slavik, Z., Kaplanova, J., & Macrae, D. (2005). Milrinone and low cardiac output following cardiac surgery in infants: is there a direct myocardial effect? Pediatric Cardiology, 26(5), 642-645. Hazinski, M. F. (1992). Nursing care of the critically ill child (2nd ed.). St. Louis: Mosby-Year Book. Jones, B., Hayden, M., Fraser, J. F., & Janes, E. (2005). Low cardiac output syndrome in children. Current Anaesthesia & Critical Care, 16(6), 347-358. Kulasekaran K, Sargent PH, & Flenady V. (2004). Milrinone for the treatment of cardiac dysfunction in neonates (Protocol) (Publication no. 10.1002/14651858.CD004952.). from John Wiley & Sons, Ltd: McCance, K Ramamoorthy, C., Anderson, G. D., Williams, G. D., & Lynn, A. M. (1998). Pharmacokinetics and side effects of milrinone in infants and children after open heart surgery. Anesthesia & Analgesia, 86(2), 283-289. Ravishankar, C., Tabbutt, S., & Wernovsky, G. (2003). Critical care in cardiovascular medicine. Current opinion in Pediatrics, 15, 443-453. Torres, A. (2010). Therapy. Efficacy and safety of milrinone in preventing low cardiac output syndrome in infants and children after corrective surgery for congenital heart disease. Retrieved 25 August, 2010. Torres, M., Pharm, D., & Nieves, J. A. (2008). Progress in Congenital Cardiac Care for newborns and Infants: The emerging Role of "off-Label" Medications. Newborn and Infand Nursing Reviews, 9(1), 18-30.

You May Also Find These Documents Helpful

  • Powerful Essays

    As heart rate increases, this allows less time for diastole and the heart often cannot fill adequately. Therefore, a very rapid heart will often have a reduced cardiac output, especially in an elderly individual…

    • 4125 Words
    • 17 Pages
    Powerful Essays
  • Good Essays

    Beta-blockers block the action of the sympathetic nervous system of the heart, thus reducing stress on the heart. The sympathetic nervous system activates the "fight or flight" response. It is part of the autonomic nervous system.…

    • 813 Words
    • 4 Pages
    Good Essays
  • Powerful Essays

    Asthmaken Case Study

    • 408 Words
    • 2 Pages

    2) Bradycardia (.5-1 mg IV every 3-5 min up to 3 mg, 6 mg max if given ET)…

    • 408 Words
    • 2 Pages
    Powerful Essays
  • Better Essays

    2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010;122(18 suppl 3):S640-S933.…

    • 912 Words
    • 4 Pages
    Better Essays
  • Better Essays

    Hca 240 Final Project

    • 1640 Words
    • 7 Pages

    References: Amsterdam EA. Revised American College of Cardiology/American Heart Association guidelines for the management of heart failure. Prev Cardiol. 2005 Fall;8(4):254, 256.Heart Failure Society Of America. Evaluation and management of patients with acute decompensated heart failure. J Card Fail. 2006 Feb;12(1):e86-e103. Review.…

    • 1640 Words
    • 7 Pages
    Better Essays
  • Better Essays

    Capital Budget Request

    • 1892 Words
    • 8 Pages

    According to the Centers for Disease Control, Critical Congenital Heart Disease (CCHD) accounts for approximately twenty-four percent of all infant deaths related to birth defects (2011). Congenital heart defects in infants may not be diagnosed until after the patent ductus arteriosus closes which typically occurs after the infant is discharged to home. Every year approximately 4,800 infants are born with CCHD and if left untreated these infants can suffer serious health issues and or death (Centers for Disease Control, 2011). It is the recommendation of both the CDC and the American Academy of Pediatrics to screen all infants for CCHD prior to discharge. Pulse oximetry screening can help to identify children with CCHD before they show symptoms of CCHD. The mission of Licking Memorial Hospital is “To Improve the Health of the Community”. In order to ensure that the mission is successfully achieved; the maternity department is proposing to purchase portable pulse oximetry units for newborn screening. The portable pulse oximetry units would ensure that all babies delivered at Licking Memorial Hospital would have access to Critical Congenital Heart Disease screening prior to discharge.…

    • 1892 Words
    • 8 Pages
    Better Essays
  • Good Essays

    Insufficient cardiac output causes compensatory mechanisms work to improve cardiac output. They include, sympathetic nervous system stimulation, Renin=angiotensin system activation, other chemical responses, and myocardial hypertrophy.…

    • 864 Words
    • 4 Pages
    Good Essays
  • Powerful Essays

    This is especially true in very low birth neonates. Emergency primary balloon angioplasty is very effective acutely. It decreases mortality providing a bridge to surgery in critically ill neonates. It relives the heart failure and acidosis. Successful and safe balloon angioplasty has been reported in small neonates weighing as low as 790 grams. However, the rate of developing of recoarctation in primary balloon angioplasty is much higher comparing with surgically treated patients. This rate is more than 50 % in the vast majority of the studies.…

    • 1101 Words
    • 5 Pages
    Powerful Essays
  • Satisfactory Essays

    In the occurrence of a cardiac affiliated medical emergency, the health of a preschooler will rapidly decline if he or she is not accurately assessed in a time sensitive manner. Many of the potential life threatening emergencies require interventions immediately and cannot be postponed for a drive to the hospital. There is a myriad of different matters to address when considering the prehospital cardiac assessment of a preschool-aged child; two of the most vital lifesaving procedures require assessment of skin color and assessment of the heart rate.…

    • 359 Words
    • 2 Pages
    Satisfactory Essays
  • Good Essays

    Pahl on the Cardiac Care Unit at Lurie Children’s Hospital, I witnessed the true art of healing. A young boy’s heart was growing weaker by the day. Dr. Pahl looked at the left ventricular ejection fraction trending lower and lower. I heard one of the patient’s nurses explain that the young boy no longer had the energy to sit up and do his schoolwork. I could not stop thinking about this patient and how quickly his transplanted heart declined.…

    • 860 Words
    • 4 Pages
    Good Essays
  • Satisfactory Essays

    final study guide peds

    • 331 Words
    • 2 Pages

    CV- cardiac defects cyanotic =hypoxemia & acyanotic= not as severe hypoxemia as cyanotic pale TOFVSD, OA, PS, RUA ASD atrium VSD ventricle COAstress aorta PDA closure DA HF for all of this know top 3 NDX, maslows, ABC, nursing interventions with the rationale such as the following. O2 (oxygen(A), ventilation(B) and perfusion(C)) positioning semi or high fowlers, decrease HOB if in shock or if decrease BP to get blood back to the heart. Monitor I & O’s for balance, Daily weights most important. Nutrition fluids/diet/enteral (gut) feedings/TPN. Medications admin protocol, path, meds digoxin +ino -chromo, toxicity =n/v, halo, labs 0.5-2ng, apical HR, watch K+ levels(3.5-5.5) don’t give if hypo because ? . Diuretics, morphine protocals for giving meds to children know weight, give parents s/s side effects, don’t regive meds if child thru it up because you don’t know how much they got, parents need to know the dos/don’t of medications. Don’t tell them its candy.…

    • 331 Words
    • 2 Pages
    Satisfactory Essays
  • Better Essays

    Congestive heart failure is a very common disease. While many other forms of heart disease have become less common, heart failure has been increasing. Congestive heart failure has become the most common diagnosis in the hospital for patients over 65 years of age. Diastolic heart failure accounts for up to 40% of patients with congestive heart failure and is associated with a better prognosis as compared to patient with systolic dysfunction (Arora, Krummerman, Vijayaraman, Rosengarten, Suryadevara, Lejemtel, and Ferrick, 2005). Congestive heart failure occurs when the flow of…

    • 847 Words
    • 4 Pages
    Better Essays
  • Best Essays

    Aylott, M. (2006b) ‘Observing the sick child: part 2c respiratory auscultation’, Paediatric Nursing, 19(3), pp. 38-45.…

    • 4906 Words
    • 20 Pages
    Best Essays
  • Powerful Essays

    Moving onto C for circulation, I was looking at signs of cardiovascular failure. I started by taking Alfie’s heart rate using the monitor as well as finding his radial pulse point. I believed it was important to take a manual pulse as it enables me to feel for the rate, rhythm and amplitude of each beat (Merrifield and Ford, 2005). According to (Pritchard and Mallett, 2001) Alfie was presenting with tachycardia as his heart rate was 150 beats per minute, outside the normal, safe ranges for a 3 year old. The rhythm of his heart was normal showing that there wasn’t a disruption of the hearts normal conductive system and the amplitude was “strong and bounding” (Trim, 2005). I was expecting Alfie’s heart rate to be high due to his increased respiratory efforts. We observed Alfie regularly to insure that our interventions were effective and decreasing his signs of discomfort. I took Alfie’s temperate to see that it was 40°C but he was not showing any signs of being distressed. Research (Choices, 2014, Coad and Glasper, 2014, p169) suggests that antipyretics shouldn’t be given to a child who is comfortable with a temperature but my mentor, Alfie’s parents and I decided that due to his raised vital signs it would be beneficial for Alfie to have some paracetamol to bring the vital signs back to their normal ranges. Alfie was observed frequently after to ensure the medication was…

    • 2141 Words
    • 9 Pages
    Powerful Essays
  • Good Essays

    Flolan at 50 ng/kg/min exerted pulmonary vasodilator effects similar to iNO at 20 ppm, with comparable decreases in mPAP and PVR, while mBP and SVR remained unaltered. But it has to be admitted that despite the fact that nitric oxide is costly and exert some damaging effects but it is more selective on the pulmonary vasculature than Flolan. After considering all the aspects, Flolan is a better option because of it low cost and efficacy in treating PAH in infants (Khan, T.A., Schnickel, G,…

    • 1469 Words
    • 6 Pages
    Good Essays