A comparison of prostacyclin and sodium nitroprusside for the treatment of heart failure after cardiac surgery |
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Authors: | N Kieler-Jensen E Houltz SE Ricksten |
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Affiliation: | Department of Anesthesia and Intensive Care, University of Gothenburg, Sweden. |
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Abstract: | OBJECTIVE: To study the effects of the two vasodilators, prostacyclin and sodium nitroprusside, on central hemodynamics in heart failure after cardiac surgery. DESIGN: Randomized cross-over study. SETTING: Multi-institutional university hospital. PARTICIPANTS: Ten patients. Inclusion criteria: cardiac index less than 2.5 L/min/m2; pulmonary capillary wedge pressure greater than 15 mmHg, systemic vascular resistance index greater than 2,500 dynes.s.cm-5/m2, and treatment with inotropic support. Five patients were treated with intra-aortic balloon counterpulsation. INTERVENTIONS: After control measurements, mean arterial pressure was decreased by 10% to 20% with each vasodilator in each patient. MEASUREMENTS AND RESULTS: Sodium nitroprusside induced decreases in mean pulmonary arterial pressure (-21%), pulmonary capillary wedge pressure (-29%), central venous pressure (-17%), and systemic vascular resistance (-25%), and increases in cardiac output (+7%) and stroke volume (+6%) compared with control. Prostacyclin decreased mean pulmonary arterial pressure (-14%), pulmonary capillary wedge pressure (-19%), central venous pressure (-7%), and systemic (-40%) and pulmonary (-25%) vascular resistances, whereas cardiac output (+25%) and stroke volume (+22%) increased compared with control. Prostacyclin, compared with sodium nitroprusside, induced a more pronounced increase in cardiac output and stroke volume, associated with less pronounced decreases in cardiac filling pressures and more profound decreases in systemic and pulmonary vascular resistances. CONCLUSION: Prostacyclin appears to be a useful agent, superior to sodium nitroprusside, in the treatment of postoperative heart failure in patients with normal or mildly elevated cardiac filling pressures, where vasodilator treatment is indicated. |
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