Refractory hypoxemia associated with neonatal pulmonary disease: the use and limitations of tolazoline.
Thirty-nine critically ill infants with pulmonary disease received tolazoline because of severe hypoxemia refractory to administration of 100% O2 and mechanical ventilation. Twenty-seven (69%) of the infants responded with an increase in PaO2 greater than or equal to 20 torr in the first umbilical arterial gas after completion of the initial ten-minute infusion (1 to 2 mg/kg) of the drug. A response was not correlated with survival. The overall survival was 46%, essentially unchanged from our previous report (44%). Infants with hyaline membrane disease had the poorest survival rate (33%). Complications associated with the use of tolazoline occurred in 82% of the infants. A hypotensive reaction, defined as a 25% decrease in mean arterial pressure from the pre-tolazoline level, occurred in 67% of the infants, and more commonly in the infants with RDS (87%). In 11 infants who did not respond to the initial dose of tolazoline, the dose was increased up to 10 mg/kg/hour; only one infant responded, and eight (73%) had a hypotensive reaction.
D002245:Carbon Dioxide / Q000097:blood; D006801:Humans; D006819:Hyaline Membrane Disease / Q000150:complications / Q000401:mortality; D000860:Hypoxia / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000150:complications* / Q000401:mortality; D001239:Inhalation; D008171:Lung Diseases / Q000150:complications* / Q000401:mortality; D008470:Meconium; D010100:Oxygen / Q000097:blood; D010102:Oxygen Inhalation Therapy; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000150:complications; D013577:Syndrome; D014043:Tolazoline / Q000009:adverse effects / Q000627:therapeutic use*; D014469:Umbilical Arteries
D002245:Carbon Dioxide; D014043:Tolazoline; D010100:Oxygen