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Beneficialhemodynamic and renaleffects ofintravenousenalaprilat followingcoronary arterybypass surgerycomplicated by leftventriculardysfunction* Frank WagnerR. YeterSusanne Bisson2003 год

Beneficial hemodynamic and renal effects of intravenous enalaprilat following coronary artery bypass surgery complicated by left ventricular dysfunction*
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Аннотация: Objective Angiotensin-converting enzyme inhibitors are an effective therapy for all stages of heart failure due to reduced systolic left ventricular function. Because sufficient data on intravenous angiotensin-converting enzyme inhibitors following coronary artery bypass surgery complicated by postoperative left ventricular dysfunction are unavailable, the efficacy and safety of intravenously administered enalaprilat were evaluated. Design A placebo-controlled, randomized, double-blind protocol. Setting Postoperative intensive care unit at the German Heart Institute Berlin. Patients Forty patients with a left ventricular ejection fraction <35% following coronary artery bypass surgery on the second postoperative day or after weaning from intra-aortic balloon counterpulsation. Interventions A loading dose of enalaprilat 0.625 mg infused over 1 hr was followed by 5 mg/24 hrs administered continuously for up to 72 hrs. Measurements and Main Results Systemic and pulmonary hemodynamic variables, blood gases, hormonal variables, renal function, and electrolytes were measured before and repeatedly during therapy. Acute effects were as follows: At 1 hr, enalaprilat increased the cardiac index (p < .001), stroke volume index (p < .001), and right ventricular stroke work index (p < .03) compared with placebo, whereas mean arterial pressure (p < .008) and both systemic (p < .001) and pulmonary (p < .02) vascular resistance decreased. Continuous effects were as follows: Over 72 hrs, enalaprilat decreased diastolic pulmonary artery pressure (p < .019), pulmonary artery occlusion pressure (p < .02), and central venous pressure (p < .02). The cardiac and stroke volume indexes were consistently higher in the enalaprilat group, whereas systemic and pulmonary vascular resistances were lower. The arterial blood-pressure lowering effect was blunted and heart rate remained unchanged. Mixed venous oxygenation (p < .02) was higher and arterial oxygenation was not modified. Finally, enalaprilat increased creatinine clearance (p < .002) and decreased creatinine (p < .02) and urea (p < .03). Conclusions Intravenous enalaprilat safely and effectively improves cardiac and renal function following coronary artery bypass surgery complicated by postoperative left ventricular dysfunction.
Год издания: 2003
Авторы: Frank Wagner, R. Yeter, Susanne Bisson, Henryk Siniawski, Roland Hetzer
Издательство: Lippincott Williams & Wilkins
Источник: Critical Care Medicine
Ключевые слова: Heart Failure Treatment and Management, Cardiac, Anesthesia and Surgical Outcomes, Cardiac Arrest and Resuscitation
Другие ссылки: Critical Care Medicine (HTML)
PubMed (HTML)