title: Vasoactive Drugs and Hemodynamic Monitoring in Pediatric Cardiac Intensive Care: An Italian Survey.
abstract: BACKGROUND
  Little is known about practitioner preference, the availability of technology, and variability in practice with respect to hemodynamic monitoring and vasoactive drug use after congenital heart surgery. The aim of this study was to characterize current hospital practices related to the management of low cardiac output syndrome (LCOS) across Italy.
  
  
  METHODS
  We issued a 22-item questionnaire to 14 Italian hospitals performing pediatric cardiac surgery.
  
  
  RESULTS
  Electrocardiogram, invasive blood pressure, central venous pressure, pulse oximetry, diuresis, body temperature, arterial lactate, and blood gas analysis were identified as routine in hemodynamic monitoring. With regard to advanced hemodynamic monitoring, pulmonary arterial catheter and transpulmonary thermodilution were available in 43% of the centers, uncalibrated pulse contour methods in 29% of the centers, and transesophageal/transthoracic echocardiograms in all of the centers. Dopamine added to milrinone was the most frequent drug regimen for LCOS prevention after cardiopulmonary bypass. Overall, 86% of centers used milrinone alone as the initial treatment for LCOS with elevated systemic vascular resistances and levosimendan, the second preferred choice. In cases of LCOS with low vascular resistance, epinephrine was the first choice (10 centers), dopamine was the second choice (4 centers), followed by vasopressin and norepinephrine (3 centers). For treatment of LCOS with elevated pulmonary resistances, milrinone was the first choice (eight centers), followed by inhaled nitric oxide (five centers).
  
  
  CONCLUSIONS
  The survey shows that advanced hemodynamic monitoring is rarely performed. The most commonly used vasoactive drugs are milrinone, levosimendan, dopamine, epinephrine, vasopressin, and norepinephrine. Guidelines on the topic are warranted.
authors.affiliation: Pediatric Cardiac Anesthesia/Intensive Care Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy alessandra.rizza1@virgilio.it.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Rizza
authors.affiliation: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Bignami
authors.affiliation: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Belletti
authors.affiliation: Pediatric Cardiac Anesthesia/Intensive Care Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Polito
authors.affiliation: Pediatric Cardiac Anesthesia/Intensive Care Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: Zaccaria
authors.initials: Z
authors.lastname: Ricci
authors.affiliation: Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese (Milan), Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Isgrò
authors.affiliation: Cardiovascular Department, Santa Croce Hospital, Cuneo, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Locatelli
authors.affiliation: Pediatric Cardiac Anesthesia/Intensive Care Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Cogo
mesh_terms: D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002648:Child; D003325:Coronary Care Units / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005260:Female; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D015278:Intensive Care Units, Pediatric; D007558:Italy; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D011182:Postoperative Care; D011795:Surveys and Questionnaires
chemical_list: D002316:Cardiotonic Agents
keywords: cardiopulmonary bypass; circulatory hemodynamics; congenital heart disease; inflammatory response; intensive care