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Matsushita FY, Krebs VLJ, de Campos CV, de Vincenzi Gaiolla PV, de Carvalho WB. Reassessing the role of milrinone in the treatment of heart failure and pulmonary hypertension in neonates and children: a systematic review and meta-analysis. Eur J Pediatr 2024; 183:543-555. [PMID: 37999764 DOI: 10.1007/s00431-023-05342-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023]
Abstract
To evaluate milrinone's impact on pediatric cardiac function, focusing on its specific role as an inotrope and lusitrope, while considering its systemic and pulmonary vasodilatory effects. Search of PubMed, EMBASE, and the Cochrane Library up to August 2023. We included all studies that evaluated milrinone in children under 18 years old in neonatal, pediatric, or cardiac intensive care units. We excluded case reports, studies that did not provide tabular information on milrinone's outcomes, and studies focused on non-intensive care populations. We extracted data on the research design, objectives, study sample, and results of each study, including the impact of milrinone and any associated factors. We screened a total of 9423 abstracts and 41 studies were ultimately included. Milrinone significantly improved left ventricular ejection fraction (WMD 3.41 [95% CI 0.61 - 6.21]), left ventricle shortening fraction (WMD 4.25 [95% CI 3.43 - 5.08]), cardiac index (WMD 0.50 [95% CI 0.32 to 0.68]), left ventricle output (WMD 55.81 [95% CI 4.91 to 106.72]), serum lactate (WMD -0.59 [95% CI -1.15 to -0.02]), and stroke volume index (WMD 2.95 [95% CI 0.09 - 5.82]). However, milrinone was not associated with improvements in ventricular myocardial performance index (WMD -0.01 [95% CI -0.06 to 0.04]) and ventricular longitudinal strain (WMD -2.14 [95% CI -4.56 to 0.28]). Furthermore, milrinone was not associated with isovolumetric relaxation time reduction (WMD -8.87 [95% CI -21.40 to 3.66]). CONCLUSION Our meta-analysis suggests potential clinical benefits of milrinone by improving cardiac function, likely driven by its systemic vasodilatory effects. However, questions arise about its inotropic influence and the presence of a lusitropic effect. Moreover, milrinone's pulmonary vasodilatory effect appears relatively weaker compared to its systemic actions. Further research is needed to elucidate milrinone's precise mechanisms and refine its clinical applications in pediatric practice. WHAT IS KNOWN • Milrinone is a phosphodiesterase III inhibitor that has been used to treat a variety of pediatric and neonatal conditions. • Milrinone is believed to exert its therapeutic effects by enhancing cardiac contractility and promoting vascular relaxation. WHAT IS NEW • Milrinone may not have a significant inotropic effect. • Milrinone's pulmonary vasodilatory effect is less robust than its systemic vasodilatory effect.
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Affiliation(s)
- Felipe Yu Matsushita
- Department of Pediatrics, Neonatology Division, Faculty of Medicine of the University of São Paulo, Instituto da Criança, Av. Dr. Enéas de Carvalho Aguiar, 647, São Paulo, 05403-000, Brazil.
- Department of Pediatric Cardiology, Faculty of Medicine of the University of São Paulo, Instituto do Coração, São Paulo, Brazil.
- Department of Pediatrics and Neonatology, Hospital Samaritano, São Paulo, São Paulo, Brazil.
| | - Vera Lúcia Jornada Krebs
- Department of Pediatrics, Neonatology Division, Faculty of Medicine of the University of São Paulo, Instituto da Criança, Av. Dr. Enéas de Carvalho Aguiar, 647, São Paulo, 05403-000, Brazil
| | - Carolina Vieira de Campos
- Department of Pediatric Cardiology, Faculty of Medicine of the University of São Paulo, Instituto do Coração, São Paulo, Brazil
| | | | - Werther Brunow de Carvalho
- Department of Pediatrics, Neonatology Division, Faculty of Medicine of the University of São Paulo, Instituto da Criança, Av. Dr. Enéas de Carvalho Aguiar, 647, São Paulo, 05403-000, Brazil
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Xingzhu D, Qingrui Z, Keren C, Yuxi L, Yunpeng H, Shien Z, Xiangwei F. Cryopreservation of Porcine Embryos: Recent Updates and Progress. Biopreserv Biobank 2021; 19:210-218. [PMID: 33625892 DOI: 10.1089/bio.2020.0074] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Cryopreservation of embryos is important for long-distance embryo transfer and conservation of genetic resources. Porcine research is important for animal husbandry and biomedical research. However, porcine embryos are difficult to cryopreserve because of their high cytoplasmic lipid content and sensitivity to chilling stress. Vitrification is more efficient than slow freezing, and vitrification is mostly used in embryo cryopreservation. So far, the vitrification process of porcine embryos has been continuously improved, resulting in improved survival rates of warmed embryos and farrowing rates after the transplant procedure. It is worth noting that automatic vitrification has made great progress, which is expected to promote the standardization and application of vitrification. In this article, the vitrification process of porcine embryos at the blastula stage and early development stages is reviewed in detail. In addition, the efficiency of different vitrification systems was compared. In addition, we summarize technology that can improve the survival rate of cryopreserved porcine embryos, such as delipidation methods (including physical delipidation and chemical delipidation) and medium improvements (including chemically defined media and adding antioxidants). Meanwhile, gene expression changes during cryopreservation are also elaborated.
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Affiliation(s)
- Du Xingzhu
- National Engineering Laboratory for Animal Breeding, Beijing Key Laboratory for Animal Genetic Improvement, College of Animal Science and Technology, China Agricultural University, Beijing, China
| | - Zhuan Qingrui
- National Engineering Laboratory for Animal Breeding, Beijing Key Laboratory for Animal Genetic Improvement, College of Animal Science and Technology, China Agricultural University, Beijing, China
| | - Cheng Keren
- Department of Biology, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Luo Yuxi
- National Engineering Laboratory for Animal Breeding, Beijing Key Laboratory for Animal Genetic Improvement, College of Animal Science and Technology, China Agricultural University, Beijing, China
| | - Hou Yunpeng
- State Key Laboratory of Agrobiotechnology, College of Biological Sciences, China Agricultural University, Beijing, China
| | - Zhu Shien
- National Engineering Laboratory for Animal Breeding, Beijing Key Laboratory for Animal Genetic Improvement, College of Animal Science and Technology, China Agricultural University, Beijing, China
| | - Fu Xiangwei
- National Engineering Laboratory for Animal Breeding, Beijing Key Laboratory for Animal Genetic Improvement, College of Animal Science and Technology, China Agricultural University, Beijing, China
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Farias JS, Villarreal EG, Flores S, Mastropietro CW, Vogel M, Schulz K, Culichia C, Iliopoulos ID, Bronicki RA, Loomba RS. Effects of Vasopressin Infusion After Pediatric Cardiac Surgery: A Meta-analysis. Pediatr Cardiol 2021; 42:225-233. [PMID: 33155084 DOI: 10.1007/s00246-020-02496-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/30/2020] [Indexed: 11/30/2022]
Abstract
Vasopressin has been used to augment blood pressure; however, cardiovascular effects after cardiac surgery have not been well established. The primary objective of this study was to survey the current literature and quantify the pooled effect of vasopressin on hemodynamic parameters in children after pediatric cardiac surgery. A systematic review was conducted to identify studies characterizing the hemodynamic effects of vasopressin after pediatric cardiac surgery. Studies were assessed and those of satisfactory quality with pre- and post-vasopressin hemodynamics for each patient were included in the final analyses. 6 studies with 160 patients were included for endpoints during the first 2 h of infusions. Patients who received vasopressin infusion had greater mean, systolic, and diastolic blood pressures and lower heart rates at 2 h after initiation. 8 studies with 338 patients were included for the effects at 24 h. Patients who received vasopressin infusion had lower central venous pressures and decreased lactate concentrations 24 h after initiation. A subset analysis for children with functionally univentricular hearts found significant decrease in inotrope score and central venous pressure. A subset analysis for neonates found significant decrease in inotrope score and fluid balance. Vasopressin leads to decrease in heart rate and increase in blood pressure in the first 2 h of initiation. Later effects include decrease in inotrope score, central venous pressure, fluid balance, and in lactate within the first 24 h. Findings vary in neonates and in those with functionally univentricular hearts although beneficial effects are noted in both.
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Affiliation(s)
- Juan S Farias
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
| | - Enrique G Villarreal
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico.
- Department of Pediatrics, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico.
| | - Saul Flores
- Texas Children's Hospital, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Christopher W Mastropietro
- Riley's Children's Health, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Maggie Vogel
- Chicago Medical School/Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
- Advocate Children's Heart Institute/Advocate Children's Hospital, Oak Lawn, IL, USA
| | - Kelci Schulz
- Chicago Medical School/Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
- Advocate Children's Heart Institute/Advocate Children's Hospital, Oak Lawn, IL, USA
| | - Corissa Culichia
- Chicago Medical School/Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
- Advocate Children's Heart Institute/Advocate Children's Hospital, Oak Lawn, IL, USA
| | | | - Ronald A Bronicki
- Texas Children's Hospital, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Rohit S Loomba
- Chicago Medical School/Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
- Advocate Children's Heart Institute/Advocate Children's Hospital, Oak Lawn, IL, USA
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Abstract
Milrinone is a drug frequently used for hemodynamic support in children during critical illness. Although the hemodynamic changes induced by milrinone in children may appear similar to those of adults, the physiologic contributors of these changes remain vastly unknown. A systematic review was conducted to identify studies characterising the hemodynamic effects of milrinone in children during critical illness for hemodynamic support for various medical conditions. Studies were assessed for quality and those of satisfactory quality with pre- and post-operative hemodynamics for each patient were included in the final analyses. Those not limited to children and those not limited to patients with critical illness were excluded from the final analyses. A total of six studies with 791 patients were included in the final analyses. Milrinone infusion doses ranged from 0.3 to 0.75 mcg/kg/minute with the mean infusion dose being 0.5 mcg/kg/minute. Patients whom received milrinone infusion had greater cardiac output, greater left ventricle shortening fraction, lower right ventricular systolic pressure, and lower serum lactate levels. Systolic blood pressure mean arterial blood pressure and arterial oxygen concentration did not significantly change with administration of milrinone. These results were irrespective of milrinone infusion dose, infusion duration, and study size. Milrinone was found to have several beneficial hemodynamic effects in children during critical illness when used at usual clinical doses.
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Yoon SY, Eum JH, Cha SK, Yoon TK, Lee DR, Lee WS. Prematuration Culture with Phosphodiesterase Inhibitors After Vitrification May Induce Recovery of Mitochondrial Activity in Vitrified Mouse Immature Oocytes. Biopreserv Biobank 2018; 16:296-303. [DOI: 10.1089/bio.2018.0010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sook Young Yoon
- Fertility Center of CHA Gangnam Medical Center, College of Medicine, CHA University, Seoul, Korea
| | - Jin Hee Eum
- Fertility Center of CHA Gangnam Medical Center, College of Medicine, CHA University, Seoul, Korea
| | - Soo Kyoung Cha
- Fertility Center of CHA Gangnam Medical Center, College of Medicine, CHA University, Seoul, Korea
| | - Tae Ki Yoon
- Fertility Center of CHA Gangnam Medical Center, College of Medicine, CHA University, Seoul, Korea
| | - Dong Ryul Lee
- Department of Biomedical Science, College of Life Science, CHA University, Seongnam-si, Korea
| | - Woo Sik Lee
- Fertility Center of CHA Gangnam Medical Center, College of Medicine, CHA University, Seoul, Korea
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Park JB, Kwak JG, Lim HG, Kim WH, Lee JR, Kim YJ. Experience with Mechanical Circulatory Support for Medically Intractable Low Cardiac Output in a Pediatric Intensive Care Unit. Korean Circ J 2017; 47:490-500. [PMID: 28765741 PMCID: PMC5537151 DOI: 10.4070/kcj.2016.0320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/23/2016] [Accepted: 11/11/2016] [Indexed: 11/20/2022] Open
Abstract
Background and Objectives Mechanical circulatory support with extracorporeal membrane oxygenation (ECMO) and ventricular assist device has always been the optimal choice for treating the majority of medically intractable low cardiac output case. We retrospectively investigated our institution's outcomes and variables associated with a high risk of mortality. Subjects and Methods From 1999 to 2014, 86 patients who were of pediatric age or had grown-up congenital heart disease underwent mechanical circulatory support for medically intractable low cardiac output in our pediatric intensive care unit. Of these, 9 grown-up congenital heart disease patients were over 18 years of age, and the median age of the subject group was 5.82 years (range: 1 day to 41.6 years). A review of all demographic, clinical, and surgical data and survival analysis were performed. Results A total of 45 (52.3%) patients were successfully weaned from the mechanical assist device, and 25 (29.1%) survivors were able to be discharged. There was no significant difference in results between patients over 18 years and under 18 years of age. Risk factors for mortality were younger age (<30 days), functional single ventricle anatomy, support after cardiac operations, longer support duration, and deteriorated pre-ECMO status (severe metabolic acidosis and increased levels of lactate, creatinine, bilirubin, or liver enzyme). The survival rate has improved since 2010 (from 25% before 2010 to 35% after 2010), when we introduced an upgraded oxygenator, activated heart transplantation, and also began to apply ECMO before the end-stage of cardiac dysfunction, even though we could not reveal significant correlations between survival rate and changed strategies associated with ECMO. Conclusion Mechanical circulatory support has played a critical role and has had a dramatic effect on survival in patients with medically intractable heart failure, particularly in recent years. Meticulous monitoring of acid-base status, laboratory findings, and early and liberal applications are recommended to improve outcomes without critical complication rates, particularly in neonates with single ventricle physiology.
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Affiliation(s)
| | - Jae Gun Kwak
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hong-Gook Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Woong-Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jeong Ryul Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Yong Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
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García-Canales A, Peña-Juárez RA, Sandoval-Franco LDM. [Vasopressors and inotropes: use in paediatrics]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2017; 88:39-50. [PMID: 28336302 DOI: 10.1016/j.acmx.2017.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 02/14/2017] [Accepted: 02/15/2017] [Indexed: 11/16/2022] Open
Abstract
The cardiovascular system is a dynamic system, which is required to ensure adequate delivery of oxygen, nutrients, and hormones to the tissues that are necessary for cell metabolism. It also synthesises and modifies the vasoactive components that regulate vascular tone and myocardial function. These vasoactive components have demonstrated their beneficial effects in the management of paediatric patients in a critical condition with heart failure and shock. However, their use and abuse brings harmful effects, increases mortality, and is associated with arrhythmias. An increase in myocardial oxygen consumption favours the presence of ischaemia, therefore it is necessary to know the mechanism of action and indications of these drugs to minimise their harmful effects. The purpose of this review is to describe the pharmacology and clinical applications of inotropic and vasopressor agents in the paediatric patient in acritical condition.
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Affiliation(s)
- Adrián García-Canales
- Departamento de Terapia Intensiva Pediátrica, Hospital Regional Valentín Gómez Farías, ISSSTE, Zapopan, Jalisco, México.
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