title: Intratracheal Milrinone Bolus Administration During Acute Right Ventricular Dysfunction After Cardiopulmonary Bypass.
abstract: OBJECTIVE
  To evaluate intratracheal milrinone (tMil) administration for rapid treatment of right ventricular (RV) dysfunction as a novel route after cardiopulmonary bypass.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  Single-center study.
  
  
  METHODS
  The study comprised 7 patients undergoing cardiac surgery who exhibited acute RV dysfunction after cardiopulmonary bypass.
  
  
  METHODS
  After difficult weaning caused by cardiopulmonary bypass-induced acute RV dysfunction, milrinone was administered as a 5-mg bolus inside the endotracheal tube.
  
  
  RESULTS
  RV function improvement, as indicated by decreasing pulmonary artery pressure and changes of RV waveforms, was observed in all 7 patients. Adverse effects of tMil included dynamic RV outflow tract obstruction (2 patients) and a decrease in systemic mean arterial pressure (1 patient).
  
  
  CONCLUSIONS
  tMil may be an effective, rapid, and easily applicable therapeutic alternative to inhaled milrinone for the treatment of acute RV failure during cardiac surgery. However, sufficiently powered clinical trials are needed to confirm these findings.
authors.affiliation: Department of Anesthesiology and Critical Care, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Caroline Eva
authors.initials: CE
authors.lastname: Gebhard
authors.affiliation: Department of Anesthesiology and Critical Care, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Georges
authors.initials: G
authors.lastname: Desjardins
authors.affiliation: Department of Anesthesiology and Critical Care, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Cathérine
authors.initials: C
authors.lastname: Gebhard
authors.affiliation: Department of Pharmacology, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Gavra
authors.affiliation: Department of Anesthesiology and Critical Care, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada; Critical Care Division, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada. Electronic address: andre.denault@umontreal.ca.
authors.forename: André Y
authors.initials: AY
authors.lastname: Denault
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000453:epidemiology; D012189:Retrospective Studies; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D002316:Cardiotonic Agents; D020105:Milrinone
keywords: intratracheal administration; milrinone; right ventricular failure; right ventricular monitoring; transesophageal echocardiography