Study of the Acute Hemodynamic Effects of Inhaled Milrinone versus Inhaled Nitroglycerin on Mechanically Ventilated Patients with Pulmonary Hypertension after Mitral Valve Replacement Surgeries

Abstract

Abstract Background Pulmonary hypertension is a usual complication of long-standing mitral valve disease. Perioperative pulmonary hypertension is a risk factor for right ventricular failure and is an important cause of morbidity and mortality in patients with pulmonary hypertension undergoing mitral valve surgery. Aim of the Work To compare inhaled milrinone and inhaled nitroglycerin hemodynamic effects on mechanically ventilated patients with pulmonary hypertension after mitral valve replacement surgery by measuring invasive blood pressure, heart rate, central venous pressure and bedside transthoracic echocardiography to assess pulmonary artery pressure. Patients and Methods The study was conducted in National Heart Institute, Giza, Egypt during the six months between October, 2020 and March, 2021. This study was conducted on 40 patients. Patients were randomized on the basis of computer-generated random numbers into two equal groups (20 patients each) Using PASS11 program for sample size calculation. In group A, patients received inhaled nitroglycerin (50 µ/kg) and in group B, patients received inhaled milrinone (50 µ/kg) through jet nebulizer. Results Both inhaled milrinone and inhaled nitroglycerin proved to be selective pulmonary vasodilators, since they induced significant reductions in mPAP, SPAP, and DPAP. The favorable effects of both agents on the pulmonary vasculature was confirmed by both hemodynamic and echocardiographic measurements. At the same time, both agents were devoid of systemic side effects, since mean arterial pressure, systolic arterial pressure and diastolic arterial pressure were not affected. Conclusion There was no significance between two groups, so inhaled nitroglycerin appears to be an effective, easy to administer, inexpensive, available and save alternative for treatment of PH in mechanically ventilated patients after mitral valve replacement surgeries as there was no significance between two groups.