EMCrit Podcast - Critical Care and Resuscitation



This episode continues on from last time's talk by Sara Crager on Right Ventricular Failure. This is a Q&A session with a focus on inhaled pulmonary vasodilators.

Nitric Oxide

Sara likes it through ETT or Hi-Flo NC (can also be done through BIPAP)

Start at 20 ppm

See results within 5-10 minutes

Monitor with CVP

Additional Resources


* PulmCrit- Inhaled NO for submassive PE: iNOPE or iYEP?

* Review Article on Inhaled NO


 

Epoprostenol (Flolan)

May be more complicated to set-up


go back to marker 5


Epoprostenol @ 0.05 mcg/kg/min


Must have filters on the circuit


* Review Article on Inhaled EpoProst


 

Milrinone

Get the vial, you want 1 mg/ml with 15 mls in vial


5 ml (5 mg) q 6 hours (According to Dr. Crager--may be more frequent if symptoms rebound (down to q 3 hrs))


Ideally use ultrasonic nebulizer


onset ~15 minutes


Must have filters on circuit


LVOTO & RVOTO contraindication for the milrinone


 


respigard!!!


aeroneb pro


must have filters on vent


from Andre Denault Lecture

Additional Resources


* Inhaled Pulmonary Vasodilator Therapy for Management of Right Ventricular Dysfunction after Left Ventricular Assist Device Placement and Cardiac Transplantation





* A multicentre randomized-controlled trial of inhaled milrinone in high-risk cardiac surgical patients




 

Intratracheal Milrinone Bolus for a Crashing Patient

50-80 mcg/kg or 5 mg (1/2 a bolus is also used by some)


onset 4-5 minutes


from the amazing Hospitalist & the Resuscitationist Lecture 2019 by Andre Denault


 

Nitro

Need conc. of 1 mg/ml (standard bottle is 200 mcg/ml)


Doses in studies range from 2.5-25 mcg/kg/min for 10 minutes or 50 ug/kg total given over 8 minutes (perhaps easiest to put 4-5 mg in neb and let it run)


* PulmCrit- Nebulized nitroglycerin: The stealth pulmonary vasodilator hiding under your nose?




Photo by Valeriia Bugaiova on Unsplash

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