Dobutamine versus milrinone after subarachnoid hemorrhage

Andrew Naidech, Yunling Du, Kurt T. Kreiter, Augusta Parra, Brian Fred Fitzsimmons, Sean D. Lavine, E. Sander Connolly, Stephan A. Mayer, Christopher Commichau

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

OBJECTIVE: Neurogenic stunned myocardium is a well-recognized complication of subarachnoid hemorrhage. Dobutamine and milrinone are both used for neurogenic stunned myocardium, but there are few data comparing them after subarachnoid hemorrhage. METHODS: We compared the physiological dose response of dobutamine and milrinone in patients with subarachnoid hemorrhage requiring a pulmonary artery catheter. We located 11 patients who received either inotrope. Physiological data were fitted to a mixed model accounting for drug, dose, and between-patient variation. RESULTS: There were 11 patients who had 152 pulmonary artery catheter measurements. Two received both inotropes (but not within 4 h of each other), 2 only milrinone, and 7 only dobutamine. The groups had simitar clinical and physiological characteristics. After adjustment for vasopressin, milrinone was significantly more potent in increasing cardiac output (P < 0.0001) and stroke volume (P = 0.03), while decreasing vascular resistance (P < 0.0001) and systolic blood pressure (P = 0.008), than dobutamine. CONCLUSION: These data suggest that milrinone and dobutamine should be used in different clinical situations. Milrinone may be more effective in patients with severely depressed systolic function but who have at least normal vascular resistance and blood pressure and in whom raising cardiac output is the primary goal. Dobutamine may be superior when vascular resistance or blood pressure is low.

Original languageEnglish (US)
Pages (from-to)21-26
Number of pages6
JournalNeurosurgery
Volume56
Issue number1
DOIs
StatePublished - Jan 2005
Externally publishedYes

Fingerprint

Milrinone
Dobutamine
Subarachnoid Hemorrhage
Vascular Resistance
Myocardial Stunning
Blood Pressure
Cardiac Output
Pulmonary Artery
Catheters
Vasopressins
Stroke Volume
Hypotension
Pharmaceutical Preparations

Keywords

  • Congestive heart failure
  • Dobutamine
  • Milrinone
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Naidech, A., Du, Y., Kreiter, K. T., Parra, A., Fitzsimmons, B. F., Lavine, S. D., ... Commichau, C. (2005). Dobutamine versus milrinone after subarachnoid hemorrhage. Neurosurgery, 56(1), 21-26. https://doi.org/10.1227/01.NEU.0000144780.97392.D7

Dobutamine versus milrinone after subarachnoid hemorrhage. / Naidech, Andrew; Du, Yunling; Kreiter, Kurt T.; Parra, Augusta; Fitzsimmons, Brian Fred; Lavine, Sean D.; Connolly, E. Sander; Mayer, Stephan A.; Commichau, Christopher.

In: Neurosurgery, Vol. 56, No. 1, 01.2005, p. 21-26.

Research output: Contribution to journalArticle

Naidech, A, Du, Y, Kreiter, KT, Parra, A, Fitzsimmons, BF, Lavine, SD, Connolly, ES, Mayer, SA & Commichau, C 2005, 'Dobutamine versus milrinone after subarachnoid hemorrhage', Neurosurgery, vol. 56, no. 1, pp. 21-26. https://doi.org/10.1227/01.NEU.0000144780.97392.D7
Naidech A, Du Y, Kreiter KT, Parra A, Fitzsimmons BF, Lavine SD et al. Dobutamine versus milrinone after subarachnoid hemorrhage. Neurosurgery. 2005 Jan;56(1):21-26. https://doi.org/10.1227/01.NEU.0000144780.97392.D7
Naidech, Andrew ; Du, Yunling ; Kreiter, Kurt T. ; Parra, Augusta ; Fitzsimmons, Brian Fred ; Lavine, Sean D. ; Connolly, E. Sander ; Mayer, Stephan A. ; Commichau, Christopher. / Dobutamine versus milrinone after subarachnoid hemorrhage. In: Neurosurgery. 2005 ; Vol. 56, No. 1. pp. 21-26.
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AB - OBJECTIVE: Neurogenic stunned myocardium is a well-recognized complication of subarachnoid hemorrhage. Dobutamine and milrinone are both used for neurogenic stunned myocardium, but there are few data comparing them after subarachnoid hemorrhage. METHODS: We compared the physiological dose response of dobutamine and milrinone in patients with subarachnoid hemorrhage requiring a pulmonary artery catheter. We located 11 patients who received either inotrope. Physiological data were fitted to a mixed model accounting for drug, dose, and between-patient variation. RESULTS: There were 11 patients who had 152 pulmonary artery catheter measurements. Two received both inotropes (but not within 4 h of each other), 2 only milrinone, and 7 only dobutamine. The groups had simitar clinical and physiological characteristics. After adjustment for vasopressin, milrinone was significantly more potent in increasing cardiac output (P < 0.0001) and stroke volume (P = 0.03), while decreasing vascular resistance (P < 0.0001) and systolic blood pressure (P = 0.008), than dobutamine. CONCLUSION: These data suggest that milrinone and dobutamine should be used in different clinical situations. Milrinone may be more effective in patients with severely depressed systolic function but who have at least normal vascular resistance and blood pressure and in whom raising cardiac output is the primary goal. Dobutamine may be superior when vascular resistance or blood pressure is low.

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