Catecholamine-resistant hypotension and myocardial performance following patent ductus arteriosus ligation.

Noori S, McNamara P, Jain A, Lavoie PM, Wickremasinghe A, Merritt TA, Solomon T, Sekar K, Attridge JT, Swanson JR, Gillam-Krakauer M, Reese J, Poindexter BB, Brook M, Auchus RJ, Clyman RI, PDA Ligation/Hypotension Trial Investigators
J Perinatol. 2015 35 (2): 123-7

PMID: 25118721 · PMCID: PMC4310792 · DOI:10.1038/jp.2014.151

OBJECTIVE - We performed a multicenter study of preterm infants, who were about to undergo patent ductus arteriosus ligation, to determine whether echocardiographic indices of impaired myocardial performance were associated with subsequent development of catecholamine-resistant hypotension following ligation.

STUDY DESIGN - A standardized treatment approach for hypotension was followed at each center. Infants were considered to have catecholamine-resistant hypotension if their dopamine infusion was > 15 μg kg(-1)min(-1). Echocardiograms and cortisol measurements were obtained between 6 and 14 h after the ligation (prior to the presence of catecholamine-resistant hypotension).

RESULT - Forty-five infants were enrolled, 10 received catecholamines (6 were catecholamine-responsive and 4 developed catecholamine-resistant hypotension). Catecholamine-resistant hypotension was not associated with decreased preload, shortening fraction or ventricular output. Infants with catecholamine-resistant hypotension had significantly lower levels of systemic vascular resistance and postoperative cortisol concentration.

CONCLUSION - We speculate that low cortisol levels and impaired vascular tone may have a more important role than impaired cardiac performance in post-ligation catecholamine-resistant hypotension.

MeSH Terms (17)

Cardiac Surgical Procedures Cardiotonic Agents Catecholamines Dobutamine Dopamine Drug Resistance Ductus Arteriosus, Patent Echocardiography Female Humans Hypotension Infant, Newborn Infant, Premature Ligation Male Postoperative Complications Treatment Outcome

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