CC BY-NC-ND 4.0 · Journal of Cardiac Critical Care TSS 2022; 06(03): 190-194
DOI: 10.1055/s-0042-1759823
Original Article

Inhaled Milrinone via HFNC as a Postextubation Cardiopulmonary Elixir: Case Series and Review of Literature

Noopur Bansal
1   Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
,
1   Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
,
Jaffrey Kalaiselvan
1   Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
,
1   Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
,
Jasvinder Kaur Kohli
1   Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
,
1   Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
› Author Affiliations

Abstract

Pulmonary hypertension (PH) often complicates perioperative course following pediatric cardiac surgery, often presenting unique challenges to the attending cardiac anesthesiologist. Apart from difficult weaning from cardiopulmonary bypass, PH can often compound weaning from mechanical ventilation in this postoperative subset. From pathophysiological standpoint, the former can be attributed to concurrent detrimental cardiopulmonary consequences of PH as a multisystemic syndrome. Therefore, with an objective to address the affected systems, that is, cardiac and pulmonary simultaneously, we report combined use of inhaled milrinone (a pulmonary vasodilator) through high-frequency nasal cannula (oxygen reservoir and continuous positive airway pressure delivery device), purported to complement each other's mechanism of action in the management of PH, thereby hastening postoperative recovery. The article additionally presents a nuanced perspective on the advantages of combining the aforementioned therapies and hence proposing the same as a possible “postoperative cardiopulmonary elixir.”

Note

Support was provided solely from institutional and/or departmental sources.




Publication History

Article published online:
03 December 2022

© 2022. Official Publication of The Simulation Society (TSS), accredited by International Society of Cardiovascular Ultrasound (ISCU). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 
  • References

  • 1 Pascall E, Tulloh RM. Pulmonary hypertension in congenital heart disease. Future Cardiol 2018; 14 (04) 343-353
  • 2 Jančauskaitė D, Rudienė V, Jakutis G, Geenen LW, Roos-Hesselink JW, Gumbienė L. Residual pulmonary hypertension more than 20 years after repair of shunt lesions. Medicina (Kaunas) 2020; 56 (06) 297
  • 3 Magoon R. The pulmonary circuit dynamics in COVID-19!. J Anesth 2021; 35 (01) 161
  • 4 Hill NS, Roberts KR, Preston IR. Postoperative pulmonary hypertension: etiology and treatment of a dangerous complication. Respir Care 2009; 54 (07) 958-968
  • 5 Hsieh WC, Jansa P, Huang WC, Nižnanský M, Omara M, Lindner J. Residual pulmonary hypertension after pulmonary endarterectomy: a meta-analysis. J Thorac Cardiovasc Surg 2018; 156 (03) 1275-1287
  • 6 Yasuhara J, Yamagishi H. Pulmonary hypertension associated with postoperative tetralogy of Fallot. In: Nakanishi T, Baldwin H, Fineman J, Yamagishi H. eds. Molecular Mechanism of Congenital Heart Disease and Pulmonary Hypertension. Singapore: Springer; 2020
  • 7 Maggiore SM, Idone FA, Vaschetto R. et al. Nasal high-flow versus Venturi mask oxygen therapy after extubation. Effects on oxygenation, comfort, and clinical outcome. Am J Respir Crit Care Med 2014; 190 (03) 282-288
  • 8 Hernández G, Vaquero C, González P. et al. Effect of postextubation high-flow nasal cannula vs conventional oxygen therapy on reintubation in low-risk patients: a randomized clinical trial. JAMA 2016; 315 (13) 1354-1361
  • 9 Sharma S, Danckers M, Sanghavi D. et al. High Flow Nasal Cannula. [Updated 2022 May 10]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2022
  • 10 Vahdatpour CA, Ryan JJ, Zimmerman JM. et al. Advanced airway management and respiratory care in decompensated pulmonary hypertension. Heart Fail Rev 2021; 2: 1-11
  • 11 Kumar A, Joshi S, Tiwari N. et al. Comparative evaluation of high-flow nasal cannula oxygenation vs nasal intermittent ventilation in postoperative paediatric patients operated for acyanotic congenital cardiac defects. [ahead of print, September 23] Med J Armed Forces India 2022; 78 (04) 454-462
  • 12 Liu K, Wang H, Yu SJ, Tu GW, Luo Z. Inhaled pulmonary vasodilators: a narrative review. Ann Transl Med 2021; 9 (07) 597
  • 13 Laflamme M, Perrault LP, Carrier M, Elmi-Sarabi M, Fortier A, Denault AY. Preliminary experience with combined inhaled milrinone and prostacyclin in cardiac surgical patients with pulmonary hypertension. J Cardiothorac Vasc Anesth 2015; 29 (01) 38-45
  • 14 Haraldsson s A, Kieler-Jensen N, Ricksten SE. The additive pulmonary vasodilatory effects of inhaled prostacyclin and inhaled milrinone in postcardiac surgical patients with pulmonary hypertension. Anesth Analg 2001; 93 (06) 1439-1445
  • 15 Singh R, Choudhury M, Saxena A, Kapoor PM, Juneja R, Kiran U. Inhaled nitroglycerin versus inhaled milrinone in children with congenital heart disease suffering from pulmonary artery hypertension. J Cardiothorac Vasc Anesth 2010; 24 (05) 797-801
  • 16 Patel J, Patel K, Garg P, Patel S. Inhaled versus intravenous milrinone in mitral stenosis with pulmonary hypertension. Asian Cardiovasc Thorac Ann 2021; 29 (03) 170-178
  • 17 Nguyen AQ, Denault AY, Théoret Y, Perrault LP, Varin F. Inhaled milrinone in cardiac surgical patients: a pilot randomized controlled trial of jet vs. mesh nebulization. Sci Rep 2020; 10 (01) 2069
  • 18 Sablotzki A, Starzmann W, Scheubel R, Grond S, Czeslick EG. Selective pulmonary vasodilation with inhaled aerosolized milrinone in heart transplant candidates. Can J Anaesth 2005; 52 (10) 1076-1082
  • 19 Lamarche Y, Malo O, Thorin E. et al. Inhaled but not intravenous milrinone prevents pulmonary endothelial dysfunction after cardiopulmonary bypass. J Thorac Cardiovasc Surg 2005; 130 (01) 83-92
  • 20 Tominaga Y, Iwai S, Yamauchi S. et al. Post-extubation inhaled nitric oxide therapy via high-flow nasal cannula after Fontan procedure. Pediatr Cardiol 2019; 40 (05) 1064-1071
  • 21 Li J, Harnois LJ, Markos B. et al. Epoprostenol delivered via high flow nasal cannula for ICU subjects with severe hypoxemia comorbid with pulmonary hypertension or right heart dysfunction. Pharmaceutics 2019; 11 (06) 281
  • 22 Lamarche Y, Perrault LP, Maltais S, Tétreault K, Lambert J, Denault AY. Preliminary experience with inhaled milrinone in cardiac surgery. Eur J Cardiothorac Surg 2007; 31 (06) 1081-1087
  • 23 Ehrmann S. Vibrating mesh nebulisers – can greater drug delivery to the airways and lungs improve respiratory outcomes?. Eur Respir Pulmonary Dis 2018; 4 (01) 33-43
  • 24 Duke GJ. Cardiovascular effects of mechanical ventilation. Crit Care Resusc 1999; 1 (04) 388-399
  • 25 Tudoran C, Tudoran M, Lazureanu VE. et al. Evidence of pulmonary hypertension after SARS-CoV-2 infection in subjects without previous significant cardiovascular pathology. J Clin Med 2021; 10 (02) 199
  • 26 Castiglione L, Droppa M. Pulmonary hypertension and COVID-19. Hamostaseologie 2021; ••• Epub ahead of print DOI: 10.1055/a-1661-0240.
  • 27 Vogel DJ, Brame A, Hanks F, Remmington C, Chung N, Camporota L. Improved oxygenation with inhaled milrinone in mechanically ventilated patients with severe COVID-19. Br J Anaesth 2021; 127 (03) e111-e113
  • 28 Li J, Fink JB. Narrative review of practical aspects of aerosol delivery via high-flow nasal cannula. Ann Transl Med 2021; 9 (07) 590