Archives des maladies du coeur et des vaisseaux
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Arch Mal Coeur Vaiss · Sep 1990
[Left ventricular dysfunction while weaning from mechanical ventilation. Contribution of enoximone].
Mechanical ventilation is a valuable therapeutic option in left ventricular failure because of its effect on ventricular load. However, weaning cardiac patients form mechanical ventilation may result in severe pulmonary oedema, especially if it is not properly prepared. Some of the factors which contribute to pulmonary oedema are: 1) increased venous return due to the inversion ot the regime of inthrathoracic pressures and the release of catecholamines commonly observed during weaning, 2) reduction of left ventricular compliance due to myocardial ischemia, compression of the cardiac chambers by the lungs, ventricular interdependence in some cases and left ventricular dilatation in others, 3) increased left ventricular afterload due to negative intrathoracic pressures and increased systolic blood pressure. ⋯ The authors report six cases of pulmonary oedema in coronary patients after discontinuing mechanical ventilation. The administration I. V. enoximone, a phosphodiesterase inhibitor, prevented acute left ventricular dysfunction in 5 of the 6 cases and enabled successful and definitive weaning from mechanical ventilation.
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Arch Mal Coeur Vaiss · Sep 1990
Randomized Controlled Trial Comparative Study Clinical Trial[Comparison of the hemodynamic effects of dobutamine and enoximone in the treatment of low cardiac output after valvular surgery].
Forty patients developed low cardiac output states after surgery for mitral valve disease or with associated cardiac disease and were randomly allocated to two treatment groups, one group to receive Dobutamine (D) and the other Enoximone (E), a phosphodiesterase inhibitor. Haemodynamic assessment covered a 24 hour period but treatment was continued for as long as was necessary. An improvement was observed from the 15th minute of treatment. ⋯ The duration of treatment was significantly shorter in Group E than in Group D (59 +/- 22 hrs vs 86 +/- 49 hrs) as was the patient's stay in the intensive care unit (92 +/- 37 hrs vs 155 +/- 129 hrs). The duration of assisted ventilation was the same in the two groups. These results suggest that Enoximone is as effective as Dobutamine in the treatment of low cardiac output after mitral valve surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
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Arch Mal Coeur Vaiss · Sep 1990
Randomized Controlled Trial Comparative Study Clinical Trial[Arrhythmia in patients with low cardiac output after valvular surgery. Randomized, double-blind comparative study of dobutamine versus enoximone].
Forty patients with low cardiac output (cardiac index less than 2.2 l/mn/m2 and pulmonary wedge pressure greater than 15 mmHg) after valvular surgery were randomised into two groups. Patients in Group 1 were given 5 to 10 micrograms/Kg/mn of Dobutamine (D) and those In Group 2 a bolus of Enoximone (E) 1 mg/kg followed by an intravenous infusion of 5 to 10 micrograms/Kg/mn. Holter ECG monitoring over 42.65 +/- 6.02 hrs (24-48 hours) was obtained and interpreted blindly in 37/40 patients (19 Group D and 18 Group E). ⋯ No deaths occurred during the protocol period. The total duration of inotropic therapy (86 +/- 49 hours) and the period spent in the intensive care unit (155 +/- 129 hours) were longer in Group D than in Group E (60 +/- 23 hrs and 92 +/- 37 hrs, respectively; p less than .05). Antiarrhythmic therapy was used more often in Group D (4 patients) than in group E (1 patient) (p = 0.09).(ABSTRACT TRUNCATED AT 250 WORDS)
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Arch Mal Coeur Vaiss · Sep 1990
Randomized Controlled Trial Comparative Study Clinical Trial[Intravenous enoximone versus conventional treatment in acute lung edema. Preliminary results of a randomized study].
The aim of this open study was to compare the efficacy of Enoximone and conventional treatment in 44 patients with acute pulmonary edema. At the time of this interim analysis, 22 patients had received Enoximone (1 mg/kg by rapid intravenous injection every 8 hours for 48 hours) and 22 were given conventional treatment (furosemide, nitrates, dopamine-dobutamine). The treatment schedules were randomised. ⋯ In addition, it became necessary to administer Enoximone to 9 patients in the conventional treatment group. At these doses, Enoximone was at least as effective as conventional treatment of acute pulmonary edema. What is more, no secondary effects or tachyphylaxis were observed during the period of hospital treatment.
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Arch Mal Coeur Vaiss · Sep 1990
Randomized Controlled Trial Comparative Study Clinical Trial[Enoximone/dobutamine comparison in chronic congestive cardiac insufficiency with low cardiac output].
In severe chronic congestive cardiac failure the physician has the choice of two families of positive inotropic agents, the direct sympathomimetics and the phosphodiesterase inhibitors. The aim of the study was to compare the efficacy and tolerance of enoximone and dobutamine in this indication. Twenty patients with severe chronic cardiac failure with a cardiac index of less than 2.2 l/min/m2 and pulmonary capillary pressure of over 20 mmHg were randomised into two groups in an open trial. ⋯ The cardiac index increased with enoximone (+61.0%, p less than 0.01) and with dobutamine (+32.1%, p less than 0.02). This resulted mainly from an increase in the systolic index (+45.5%, p less than 0.05 with enoximone and +30.1%, p less than 0.05 with dobutamine). Pulmonary capillary pressure and total systemic resistance decreased with enoximone (-29.1%, p less than 0.001 and -36.7%, p less than 0.05 respectively) and with dobutamine (-23.4%, p less than 0.001 and -20.7%, p less than 0.05 respectively).(ABSTRACT TRUNCATED AT 250 WORDS)