Dobutamine versus milrinone after subarachnoid hemorrhage.
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 similar 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.


CONCLUSIONS
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.
Naidech
Andrew
A
Department of Neurology, Columbia University, New York, New York, USA. a-naidech@northwestern.edu
Du
Yunling
Y
Kreiter
Kurt T
KT
Parra
Augusto
A
Fitzsimmons
Brian-Fred
BF
Lavine
Sean D
SD
Connolly
E Sander
ES
Mayer
Stephan A
SA
Commichau
Christopher
C
D000318:Adrenergic beta-Agonists / Q000627:therapeutic use*; D000328:Adult; D004280:Dobutamine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000627:therapeutic use*; D017682:Myocardial Stunning / Q000188:drug therapy* / Q000209:etiology*; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D013345:Subarachnoid Hemorrhage / Q000150:complications*
D000318:Adrenergic beta-Agonists; D010726:Phosphodiesterase Inhibitors; D004280:Dobutamine; D020105:Milrinone