tailieunhanh - Báo cáo y học: " Bench-to-bedside review: Inotropic drug therapy after adult cardiac surgery – a systematic literature review"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care cung cấp cho các bạn kiến thức về ngành y đề tài: Bench-to-bedside review: Inotropic drug therapy after adult cardiac surgery – a systematic literature review. | Critical Care June 2005 Vol 9 No 3 Gillies et al. Review Bench-to-bedside review Inotropic drug therapy after adult cardiac surgery - a systematic literature review Michael Gillies1 Rinaldo Bellomo1 Laurie Doolan2 and Brian Buxton3 1 Department of Intensive Care and Medicine University of Melbourne Austin Hospital Melbourne Australia 2Department of Anaesthesia Austin Hospital Melbourne Australia 3Department of Cardiac Surgery Austin Hospital Melbourne Australia Corresponding author Rinaldo Bellomo Published online 16 December 2004 This article is online at http content 9 3 266 2004 BioMed Central Ltd Critical Care 2005 9 266-279 DOI cc3024 See commentary page 241 http content 9 3 241 Abstract Many adult patients require temporary inotropic support after cardiac surgery. We reviewed the literature systematically to establish present and classify the evidence regarding choice of inotropic drugs. The available evidence while limited in quality and scope supports the following observations although all p-agonists can increase cardiac output the best studied p-agonist and the one with the most favourable side-effect profile appears to be dobutamine. Dobutamine and phosphodiesterase inhibitors PDIs are efficacious inotropic drugs for management of the low cardiac output syndrome. Dobutamine is associated with a greater incidence of tachycardia and tachyarrhythmias whereas PDIs often require the administration of vasoconstrictors. Other catecholamines have no clear advantages over dobutamine. PDIs increase the likelihood of successful weaning from cardiopulmonary bypass as compared with placebo. There is insufficient evidence that inotropic drugs should be selected for their effects on regional perfusion. PDIs also increase flow through arterial grafts reduce mean pulmonary artery pressure and improve right heart performance in pulmonary hypertension. Insufficient data exist to allow selection of a specific .