The Perspective of the Intensivist on Inotropes and Postoperative Care Following Pediatric Heart Surgery: An International Survey and Systematic Review of the Literature
Open accessAbstract
INTRODUCTION: Inotropes are frequently being used in children undergoing heart surgery to prevent or treat low cardiac output syndrome (LCOS). There is only limited evidence that inotropes actually positively influence postoperative outcome. Our aim was to describe the current international practice variation in the use of inotropes following congenital heart surgery. METHODS: We developed an online survey regarding the postoperative use of inotropes. We sent an invitation to all 197 registered members of the Pediatric Cardiac Intensive Care Society (PCICS) to participate in the survey. We also performed a systematic review of the literature. RESULTS: Ninety-eight people (50%) responded, representing 62 international centers. Milrinone is routinely used perioperatively by 90 respondents (97%). Adrenaline/epinephrine is routinely used by 43%, dopamine by 36%, dobutamine by 11%, and levosimendan by 6%. Steroids are used routinely by 54% before initiating cardiopulmonary bypass. Vasopressin is used by 44% of respondents. The development of LCOS is monitored with lactate in 99% of respondents, physical examination (98%), intermittent mixed venous saturation (76%), continuous mixed venous saturation (13%), echocardiography (53%), core-peripheral temperature gap (29%), near-infrared spectrometry (25%), and 4% use cardiac output monitors (PiCCO, USCOM). To improve cardiac output, 42% add/increase milrinone, 37% add adrenaline, and 15% add dopamine. Rescue therapy is titrated individually, based on the patients' pathophysiology. A systematic review of the literature failed to show compelling evidence with regard to the benefit of inotropes. CONCLUSIONS: Despite the lack of sufficient evidence, milrinone is used by the vast majority of caregivers following congenital heart surgery.
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Serum lactate concentration is widely used to monitor postoperative LCOS; according to a survey study, 99% of pediatric intensivists include it in their assessments.
“Serum lactate concentration is widely used to monitor postoperative LCOS. According to a survey study, 99% of pediatric intensivists include it in their assessments [32].”
From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [32]
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“In 2011, a European survey also reported a marked variability with milrinone as the most used inotrope (71%) in pediatric cardiac surgery patients which is significantly fewer than 97% in our survey.(24) In their survey, dopamine (19%) and adrenaline (16%) were used much less frequently than in our survey (45% and 38%…”
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“Costello et al compared nesiritide with milrinone and placebo in 106 children following Fontan operation and found no difference in cardiac index or survival.(20) None of the respondents in this survey reported their use.”
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Pellicer, A., Riera, J., López‐Ortego, P., Bravo, M. C., Madero, R., Pérez‐Rodríguez, J., de Lera, C. L., Quero, J., Soto, A. B., Castro, L., et al. (2012) · Pediatric Research · doi:10.1038/pr.2012.154 · Cited by 55 · cited 1× · see citing works
“After heart surgery, levosimendan improved peripheral oxygenation (NIRS) and lowered inotrope scores in 20 children.(19) The current level of evidence is insufficient to judge whether prophylactic levosimendan prevents LCOS and mortality in pediatric patients undergoing surgery for congenital heart disease.”
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“However, a more recent metaanalysis of 20 randomized trials showed no increased mortality due to milrinone in adult patients undergoing cardiac surgery.(44) But the higher-quality trials did suggest a trend toward increased mortality with milrinone.”
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“Triiodothyronin supplementation may be a useful adjunct in the management of patients after CPB, improving cardiac index, cardiac function, and inotrope requirements, but its positive effect on clinical outcomes has not been established.(22,23,82,83) New inotropes like istaroxime, nesiritide, apelin, or omecamtiv meca…”
BackgroundEffects of Low-Dose Dobutamine on Left Ventricular Diastolic Filling in Children
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“In a pediatric study, levosimendan lowered PAP and increased cardiac index significantly more than dobutamine.(17) But when added to a standard postoperative protocol of milrinone and dopamine, levosimendan did not improve mortality, duration of MV, or hospital LOS in one study of 63 neonates.”
BackgroundInotropes in the hypoplastic left heart syndrome: Effects in an animal model
Riordan, C. J., Randsbæk, F., Storey, J. H., Montgomery, W. D., Santamore, W. P., & Austin, E. H. (1996) · The Annals of Thoracic Surgery · doi:10.1016/0003-4975(96)00297-4 · Cited by 43 · cited 2× · see citing works
“Of those 20 studies, 2 were crossover studies reporting on hemodynamic variables(5,7) and 2 were animal studies.(11,12) Of the remaining 16 studies in children, 6 studies reported on mortality.”
BackgroundMilrinone and Mortality in Adult Cardiac Surgery: A Meta-analysis
Zangrillo, A., Biondi‐Zoccai, G., Ponschab, M., Greco, M., Corno, L., Covello, R. D., Cabrini, L., Bignami, E. G., Melisurgo, G., & Landoni, G. (2011) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2011.06.022 · Cited by 43 · cited 1× · see citing works
“In adults there have been concerns of chronic use of milrinone increasing mortality.(42,43) However, a more recent metaanalysis of 20 randomized trials showed no increased mortality due to milrinone in adult patients undergoing cardiac surgery.”
BackgroundPharmacokinetics of dopamine in infants and children
Eldadah, M. K., Schwartz, P. H., HARRISON, R., & Newth, C. J. L. (1991) · Critical Care Medicine · doi:10.1097/00003246-199108000-00006 · Cited by 42 · cited 1× · see citing works
“Side effects are increased myocardial oxygen consumption, arrhythmias, hypothyroidism, and impaired T-lymphocyte proliferation.(55,58,59) In one adult study comparing dobutamine with dopamine, both drugs increased myocardial oxygen uptake but dopamine seemed to cause coronary constriction.”
BackgroundHummel, J., Rücker, G., & Stiller, B. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011312.pub3 · Cited by 40 · cited 1× · see citing works
“The current level of evidence is insufficient to judge whether prophylactic levosimendan prevents LCOS and mortality in pediatric patients undergoing surgery for congenital heart disease.(74) The use of levosimendan is reported by 5% of respondents of this survey.”
BackgroundMainwaring, R. D., Capparelli, E. V., Schell, K. H., Acosta, M., & Nelson, J. C. (2000) · Circulation · doi:10.1161/01.cir.101.12.1423 · Cited by 37 · see citing works
RENAL FUNCTION AFTER CARDIOPULMONARY BYPASS IN CHILDREN: COMPARISON OF DOPAMINE WITH DOBUTAMINE
Wenstone, R., CAMPBELL, J. M., Booker, P. D., & McKay, R. (1991) · British Journal of Anaesthesia · doi:10.1093/bja/67.5.591 · Cited by 36 · cited 1× · see citing works
“When compared to dobutamine, there was no difference in renal function or urine output in 142 children after heart surgery.(6) Again, to our knowledge, there is no literature on the effect of dopamine on clinically relevant outcomes in children after heart surgery.”
ResultEffects of Dopamine and Dobutamine on Regional Blood Flow Distribution in the Neonatal Piglet
Ferrara, J. J., Dyess, D. L., Peeples, G. L., Christenberry, D. P., Roberts, W. S., Tacehi, E. J., Swafford, A. N., Ardell, J. L., & Powell, R. W. (1995) · Annals of Surgery · doi:10.1097/00000658-199505000-00011 · Cited by 34 · cited 3× · see citing works
“Dopamine also causes an increase in cerebral, cardiac, and intestinal blood flow in term and preterm animals, which is dose dependent.(54) Dopamine has not been proven useful in the prevention or alteration of the course of acute renal failure.”
BackgroundResultTreatment for paediatric low cardiac output syndrome: results from the European EuLoCOS-Paed survey
Vogt, W., & Läer, S. (2011) · Archives of Disease in Childhood · doi:10.1136/archdischild-2011-300370 · Cited by 32 · cited 2× · see citing works
“In the European and Italian surveys, milrinone was most often used for the treatment of LCOS with elevated SVR or elevated PVR.25,26 In the European study, dobutamine is preferred for the treatment of LCOS with low SVR, but adrenaline/epinephrine or dopamine were first and second choice in the Italian survey.”
MethodGünnicker, M., Brinkmann, M., Donovan, T., Freund, U., Schieffer, M., & Reidemeister, J. C. (1995) · The Thoracic and Cardiovascular Surgeon · doi:10.1055/s-2007-1013790 · Cited by 30 · see citing works
Venkataraman, P. S., Wilson, D., Sheldon, R. E., Rao, R., & Parker, M. K. (1985) · PEDIATRICS · doi:10.1542/peds.76.4.543 · Cited by 29 · see citing works
Oualha, M., Urien, S., Spreux‐Varoquaux, O., Bordessoule, A., D’Agostino, I., Pouard, P., & Tréluyer, J. (2014) · Critical Care · doi:10.1186/cc13707 · Cited by 29 · cited 1× · see citing works
“1 mg/kg/min), it stimulates the beta-adrenergic receptors leading to increased contractility, increased heart rate, and afterload reduction through peripheral vasodilation.(45,46) At higher doses (>0.”
BackgroundDeakin, C. D., Knight, H., Edwards, J. C., Monro, J. L., Lamb, R. K., Keeton, B., & Salmon, A. P. (1998) · Anaesthesia · doi:10.1046/j.1365-2044.1998.00563.x · Cited by 29 · cited 1× · see citing works
“Following congenital heart surgery, moderate hypothermia (32 C-33 C) has been used in children with refractory low cardiac output state.(84) In the retrospective study, cooling led to a significant increase in MAP, pH, and urine output and a decrease in heart rate, right atrial pressure, and platelet count.”
MethodBooker, P. D., EVANS, C., & Franks, R. (1995) · British Journal of Anaesthesia · doi:10.1093/bja/74.4.419 · Cited by 28 · see citing works
Roeleveld, P. P., & Zwijsen, E. G. (2017) · World Journal for Pediatric and Congenital Heart Surgery · doi:10.1177/2150135117690104 · Cited by 27 · cited 1× · see citing works
“The management of hypertension in patients who underwent surgery for coarctation of the aortae was part of the same survey and published separately.(4) Most questions could be answered with multiple answers.”
BackgroundNitroprusside and epinephrine for treatment of low output in children after open-heart surgery.
Benzing, G., Helmsworth, J. A., Schreiber, J., & Kaplan, S. (1979) · Annals of Thoracic Surgery · doi:10.1016/s0003-4975(10)63363-2 · Cited by 26 · cited 1× · see citing works
“In 1979, Benzing et al reported that the cardiac index in 13 children after cardiac surgery increased significantly when epinephrine was added to sodium nitroprusside, without a significant change in systemic resistance.(47) In animal models of single ventricle physiology, adrenaline increased cardiac output, systemic…”
BackgroundHummel, J., Rücker, G., & Stiller, B. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011312.pub2 · Cited by 26 · see citing works
Martikainen, T. J., Uusaro, A. V., Tenhunen, J. J., & Ruokonen, E. (2004) · Acta Anaesthesiologica Scandinavica · doi:10.1111/j.0001-5172.2004.00435.x · Cited by 25 · see citing works
Bailey, J. M., Miller, B. E., Kanter, K. R., Tosone, S. R., & Tam, V. K. H. (1997) · Anesthesia & Analgesia · doi:10.1097/00000539-199702000-00010 · Cited by 25 · cited 1× · see citing works
“Amrinone, a phosphodiesterase inhibitor, is not being used anymore but has been shown to increase cardiac output in children following heart surgery.(9,13,14)”
BackgroundHemodynamic Effects of Calcium Gluconate Administered to Conscious Horses
Grubb, T., Foreman, J. H., Benson, G. J., THURMON, J. C., Tranquilli, W. J., Constable, P. D., Olson, W. O., & DAVIS, L. E. (1996) · Journal of Veterinary Internal Medicine · doi:10.1111/j.1939-1676.1996.tb02087.x · Cited by 25 · cited 3× · see citing works
“Dopamine also has dose-dependent actions but with relatively unpredictable dose response.5,55 In low doses ( 5 mg/kg/min) dopamine acts on dopaminergic receptors inducing natriuresis, diuresis, and increased mesenteric flow.54,56 In medium dose (5-15 mg/kg/min) dopamine stimulates beta1adrenergic receptors increasing…”
BackgroundVogt, W. (2013) · Clinical Pharmacokinetics · doi:10.1007/s40262-013-0096-z · Cited by 24 · cited 2× · see citing works
“It might be that underdosing of milirinone can explain the lack of positive effects on clinically relevant outcomes.(39) A pharmacological study in 2013 showed that a median dose of milrinone of 0.”
BackgroundBailey, J. M., Miller, B. E., Kanter, K. R., Tosone, S. R., & Tam, V. K. H. (1997) · Anesthesia & Analgesia · doi:10.1213/00000539-199702000-00010 · Cited by 24 · see citing works
Laitinen, P. O., Happonen, J.-M., Sairanen, H. I., Peltola, K., Rautiainen, P., Korpela, R., & Leijala, M. A. (1997) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1016/s1053-0770(97)90123-3 · Cited by 23 · cited 2× · see citing works
“Amrinone, a phosphodiesterase inhibitor, is not being used anymore but has been shown to increase cardiac output in children following heart surgery.(9,13,14)”
BackgroundMethodINNES, P. A., Frazer, R. S., Booker, P. D., ALLSOP, E., Kirton, C. A., Lockie, J., & Franks, R. (1994) · British Journal of Anaesthesia · doi:10.1093/bja/72.1.77 · Cited by 22 · cited 2× · see citing works
“When compared to enoximone, dobutamine also increased the MAP, but there was no difference in cardiac output in a study of 28 children following heart surgery.(10) The authors did not comment on mortality, duration of MV, or LOS.”
ResultPerioperative manipulation of the circulation in children with congenital heart disease
Shekerdemian, L. S. (2009) · Heart · doi:10.1136/hrt.2005.069237 · Cited by 22 · cited 1× · see citing works
“But the (cardiac) intensivist does have a number of pharmacological options at his or her disposal with well-known hemodynamic effects.(27)”
BackgroundReddy, V. M., Liddicoat, J. R., McElhinney, D. B., Fineman, J. R., Klein, J. R., Chang, R., & Hanley, F. L. (1996) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(96)00413-5 · Cited by 20 · cited 1× · see citing works
“In animal models of single ventricle physiology, adrenaline increased cardiac output, systemic perfusion, and systemic oxygen delivery.(12,48) Despite the fact that there are no randomized controlled trials with adrenaline in pediatric heart surgery, 45% and 40% of respondents use adrenaline for prevention and treatme…”
BackgroundLaitinen, P. O., Happonen, J.-M., Sairanen, H. I., Peltola, K., & Rautiainen, P. (1999) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1016/s1053-0770(99)90085-x · Cited by 20 · cited 3× · see citing works
“Amrinone, a phosphodiesterase inhibitor, is not being used anymore but has been shown to increase cardiac output in children following heart surgery.(9,13,14)”
BackgroundMethodGeorge, M., Lehot, J.-J., & Estanove, S. (1992) · PubMed · Cited by 20 · see citing works
Renal and hemodynamic effects of dopamine in infants following cardiac surgery
Outwater, K. M., Treves, S. T., Lang, P., Castaneda, A. R., & Crone, R. K. (1990) · Journal of Clinical Anesthesia · doi:10.1016/0952-8180(90)90105-c · Cited by 19 · cited 1× · see citing works
“In medium dose (5-15 mg/kg/min) dopamine stimulates beta1adrenergic receptors increasing cardiac output through chronotropy (mild effect), inotropy, and afterload reduction and increases glomerular filtration rate (GFR) and urine output through via dopaminergic receptors.(57) At high doses (>15 mg/kg/min) peripheral r…”
BackgroundVasoactive Drugs and Hemodynamic Monitoring in Pediatric Cardiac Intensive Care
Rizza, A., Bignami, E. G., Belletti, A., Polito, A., Ricci, Z., Isgrò, G., Locatelli, A., & Cogo, P. E. (2015) · World Journal for Pediatric and Congenital Heart Surgery · doi:10.1177/2150135115606626 · Cited by 19 · cited 4× · see citing works
“A recent single-country survey reported that a combination of dopamine and milrinone was the most frequent drug regimen for prevention of LCOS after congenital heart surgery in Italy.(26) This difference in the use of inotropes could reflect differences in European and American approach to the use of inotropes as most…”
BackgroundMethodInfluentialJaccard, C., Berner, M. E., Rouge, J., Oberhänsli, I., & Friedli, B. (1984) · PubMed · Cited by 17 · see citing works
Jaccard, C., Berner, M., Rouge, J., Oberhänsli, I., & Friedli, B. (1984) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/s0022-5223(19)38413-2 · Cited by 17 · cited 2× · see citing works
“Several adult and pediatric studies have found that dobutamine led to an increase in cardiac index in patients who underwent cardiac surgery, due to an increase in heart rate without an increase in stroke volume.(8,34,49) Myocardial oxygen uptake and coronary blood flow is increased with dobutamine.”
BackgroundKwapisz, M., Neuhäuser, C., SCHOLZ, S., Welters, I. D., LÖHR, T., Koch, T., Valeske, K., Akintürk, H., Thul, J., & MÜLLER, M. (2009) · Pediatric Anesthesia · doi:10.1111/j.1460-9592.2009.03101.x · Cited by 13 · see citing works
Guerra, G. G., Joffe, A. R., Senthilselvan, A., Kutsogiannis, D. J., & Parshuram, C. S. (2013) · Intensive Care Medicine · doi:10.1007/s00134-013-2858-3 · Cited by 11 · cited 2× · see citing works
“The authors report an important suboptimal use of milrinone but do not comment on clinical outcome measures such as duration of MV, hospital LOS, and/or mortality.(40) A pharmacokinetic drug-disease model, reported by Vogt et al, also suggests that the current dosage for prevention as well as for treatment of LCOS mig…”
BackgroundExiste-t-il encore une place pour la dopamine en réanimation pédiatrique ?
Leclerc, F., & Sadik, A. (2007) · Annales Françaises d Anesthésie et de Réanimation · doi:10.1016/j.annfar.2007.03.018 · Cited by 7 · see citing works
Effects of dopamine on liver blood flow in children with congenital heart disease
Mitchell, I. M., Pollock, J. C. S., & Jamieson, M. P. G. (1995) · The Annals of Thoracic Surgery · doi:10.1016/0003-4975(95)00809-8 · Cited by 7 · cited 1× · see citing works
“In low doses (<5 mg/kg/min) dopamine acts on dopaminergic receptors inducing natriuresis, diuresis, and increased mesenteric flow.(54,56) In medium dose (5-15 mg/kg/min) dopamine stimulates beta1adrenergic receptors increasing cardiac output through chronotropy (mild effect), inotropy, and afterload reduction and incr…”
BackgroundInfluence of intravenous calcium gluconate on saphenous vein graft flow in closed-chest patients
Goertz, A. W., Lag, M., Schütz, W., Schirmer, U. B., Beyer, M., & Georgieff, M. (1994) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1016/1053-0770(94)90166-x · Cited by 2 · see citing works
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Ломиворотов, В. В., Kornilov, I. A., Александрович, Б. В., Анатольевич, Ш. В., Bondarenko, I. V., Soynov, I. A., Voitov, A. V., Polyanskih, S., Strunin, O. V., Bogachev-Prokophiev, A. V., et al. (2020) · JAMA · doi:10.1001/jama.2020.8133 · Cited by 56 · see citing works
Perioperative Management of the Fontan Patient for Cardiac and Noncardiac Surgery
McNamara, J. R., McMahon, A., & Griffin, M. (2021) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2021.04.021 · Cited by 49 · see citing works
Loomba, R. S., & Flores, S. (2019) · Congenital Heart Disease · doi:10.1111/chd.12837 · Cited by 29 · see citing works
Hyperlactatemia: An Update on Postoperative Lactate
Stephens, E. H., Epting, C. L., Backer, C. L., & Wald, E. (2020) · World Journal for Pediatric and Congenital Heart Surgery · doi:10.1177/2150135120903977 · Cited by 28 · see citing works
“A recent survey of members of the Pediatric Cardiac Intensive Care Society found that only 32% of responders used core-to-peripheral temperature differential in the assessment of postoperative patients.(66) While systemic perfusion may appear adequate based on the markers listed earlier, clinicians also must evaluate…”
BackgroundVarodi, C., Pogăcean, F., Gheorghe, M., Mirel, V., Coroş, M., Barbu–Tudoran, L., Staden, R. S., & Pruneanu, S. M. (2020) · Sensors · doi:10.3390/s20123609 · Cited by 28 · see citing works
“As a kind of catecholamine, dopamine (DA) has been gaining increasing focus in the field of clinical research, therapeutically for its effects on the kidneys (promoting natriuresis) and on the cardiac muscle (increasing the cardiac output) [8].”
BackgroundSilvetti, S., Belletti, A., Bianzina, S., & Momeni, M. (2021) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2021.09.018 · Cited by 28 · see citing works
Identification of Time-Dependent Risks of Hemodynamic States After Stage 1 Norwood Palliation
Hoffman, G. M., Scott, J. P., Ghanayem, N. S., Stuth, E. A. E., Mitchell, M. E., Woods, R. K., Hraška, V., Niebler, R. A., Bertrandt, R. A., Mussatto, K. A., et al. (2019) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2019.06.063 · Cited by 26 · see citing works
Interventions Associated With Treatment of Low Cardiac Output After Stage 1 Norwood Palliation
Hoffman, G. M., Niebler, R. A., Scott, J. P., Bertrandt, R. A., Wakeham, M., Thompson, N. E., Ghanayem, N. S., Stuth, E. A. E., Mitchell, M. E., Woods, R. K., et al. (2020) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2020.05.068 · Cited by 24 · see citing works
Girona‐Alarcón, M., Cuaresma-González, A., Rodríguez‐Fanjul, J., Bobillo‐Pérez, S., Inarejos, E., Sánchez-de-Toledo, J., Jordán, I., & Balaguer, M. (2020) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2020.1743660 · Cited by 23 · see citing works
Harahsheh, A. S., Krishnan, A. N., DeBiasi, R. L., Olivieri, L., Spurney, C. F., Donofrio, M. T., Cross, R. J., Sharron, M. P., Frank, L. H., Berul, C. I., et al. (2021) · Cardiology in the Young · doi:10.1017/s1047951121003024 · Cited by 23 · see citing works
Trieu, C. T., Williams, T. M., Cannesson, M. P., & Marijic, J. (2019) · Anesthesiology · doi:10.1097/aln.0000000000002673 · Cited by 17 · see citing works
Lou, X., Liu, Y., Cui, Y., Li, J., Ma, L., Li, M., Minghui, Z., Chen, X., & Li, J. (2021) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2021.687150 · Cited by 11 · see citing works
Yang, M. J., Carpenter, R. J., Russell, K. W., Fenton, S. J., Yost, C. C., & Yoder, B. A. (2025) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2025.114510 · Cited by 10 · see citing works
Li, M.-Y., Lou, X., Cui, Y., Lin, R., Ning, S., Li, L., Li, J., Huang, G., Zou, M., Ma, L., et al. (2021) · Interactive Cardiovascular and Thoracic Surgery · doi:10.1093/icvts/ivab081 · Cited by 9 · see citing works
[Retracted] Effect of Intelligent Medical Data Technology in Postoperative Nursing Care
Duan, N., & Lin, G. (2022) · BioMed Research International · doi:10.1155/2022/9681769 · Cited by 8 · see citing works
“Results showed that the swelling technique signi fi cantly improved postoperative comfort and accelerated recovery time [10].”
RetractedKing, C. E., Thompson, E. J., Foote, H. P., Zimmerman, K. O., Hill, K. D., Chamberlain, R. C., & Hornik, C. P. V. (2020) · Cardiology in the Young · doi:10.1017/s1047951120004151 · Cited by 8 · see citing works
Burkhardt, B. E. U., Hummel, J., Rücker, G., & Stiller, B. (2024) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013707.pub2 · Cited by 7 · see citing works
Post-operative vomiting and enhanced recovery after congenital cardiac surgery
Parra, M. F., Brown, M. L., Staffa, S. J., Nathan, M., & Roy, N. (2022) · Cardiology in the Young · doi:10.1017/s1047951122000592 · Cited by 5 · see citing works
Pharmacological Heart Failure Therapy in Children: Focus on Inotropic Support
Schranz, D. (2019) · Handbook of experimental pharmacology · doi:10.1007/164_2019_267 · Cited by 5 · see citing works
Diwakar, A., Punetha, P., Kamat, A., & Chalam, K. S. (2025) · Annals of Cardiac Anaesthesia · doi:10.4103/aca.aca_230_24 · Cited by 4 · see citing works
“[1] However, a systematic review by Roeleveld and de Klerk [15] on the use of inotropes after pediatric cardiac surgery has failed to demonstrate the benefits of inotropes on outcomes such as mechanical ventilation.”
Willems, A., HAVAUX, R., Schmartz, D., Fils, J., Pooter, F. D., & der Linden, P. V. (2023) · Minerva Anestesiologica · doi:10.23736/s0375-9393.23.16622-3 · Cited by 4 · see citing works
Khalil, N. S. (2019) · Iris Journal of Nursing & Care · doi:10.33552/ijnc.2019.01.000520 · Cited by 3 · see citing works
“The researchers interpreted that by the fact that post-operative cardiovascular support is frequently being used in children undergoing heart surgery to improve cardiac output, so the majority of patients were associated with tachycardia as stroke volume in pediatric is rate dependent [24].”
BackgroundCardiovascular Pharmacology in Pediatric Patients with Congenital Heart Disease
Dabbagh, A., Talebi, Z., & Rajaei, S. (2023) · Springer eBooks · doi:10.1007/978-3-031-10442-8_4 · Cited by 3 · see citing works
Short term outcomes of the first pediatric cardiac surgery program in Rwanda
Ejigu, Y. M., Mlambo, V. C., Neil, K. L., Sime, H., Wong, R., Gatera, M. R., Nyirigira, G., Sewnet, Y. C., Lin, Y., Byishimo, B., et al. (2024) · Journal of Cardiothoracic Surgery · doi:10.1186/s13019-024-03295-5 · Cited by 3 · see citing works
“However, judicious use and timing of inotropes in line with available evidence can help ensure effective stabilization of postoperative cardiac function and decreased ICU stay [24, 25].”
Tran, V. A., Griffin, E., ELLIOTT, J. R. M., Scholl, R. L., Hill, R. B., Kerr, K., Khan, H., Bates, J., Zhang, X., Saroukhani, S., et al. (2025) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2025.01.008 · Cited by 2 · see citing works
Sahulee, R., & McKinstry, J. (2022) · Vessel Plus · doi:10.20517/2574-1209.2021.94 · Cited by 2 · see citing works
Nedelcu, C., Ionescu, N. S., Bizubac, A. M., Filip, C., & Cirstoveanu, C. (2025) · Life · doi:10.3390/life15101621 · Cited by 2 · see citing works
“According to a survey study, 99% of pediatric intensivists include it in their assessments [32].”
Gohil, I., Patel, H. R., Desai, D., & Kothari, J. (2023) · Heart India · doi:10.4103/heartindia.heartindia_10_23 · Cited by 1 · see citing works
Yamaguchi, T., Tomonari, Y., Utsunomiya, S., Fujioka, N., & Asano, T. (2025) · Pediatric Cardiology · doi:10.1007/s00246-025-04041-x · Cited by 1 · see citing works
Miller‐Hance, W. C., Gottlieb, E. A., & Motta, P. (2023) · Springer eBooks · doi:10.1007/978-3-031-25358-4_11 · Cited by 2 · see citing works
Anderson, D. (2020) · doi:10.11606/t.17.2020.tde-11022020-131955 · Cited by 1 · see citing works
Importance of Noninvasive Cardiac Output Measurement in Children: Feasibility or Applicability?
Nasr, V. G., & Friedman, K. G. (2021) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2021.01.022 · Cited by 1 · see citing works
Herzinsuffizienz und Hypoxämie bei Kindern und Jugendlichen
Kramer, H. H. (2019) · Springer Reference Medizin · doi:10.1007/978-3-642-54671-6_200-2
Perspective Regarding Postoperative Care Following Pediatric Heart Surgery
Kaufman, J., & da Cruz, E. M. (2018) · World Journal for Pediatric and Congenital Heart Surgery · doi:10.1177/2150135118779357
Roeleveld, P. P. (2018) · World Journal for Pediatric and Congenital Heart Surgery · doi:10.1177/2150135118779354
“However, treating vasoplegia and increasing blood pressure is not the same as increasing cardiac output, which was the focus of our review.(1) The use of vasoactive medication, vasodilators, and vasoconstrictors probably merits a survey and review on its own.”
BackgroundMethodInfluentialEhrmann, D. E., Kaufman, J., & Gist, K. M. (2020) · Current Treatment Options in Pediatrics · doi:10.1007/s40746-020-00200-9
Aspects of pediatric hemodynamics. A study of young children undergoing corrective heart surgery.
Sigurdsson, T. S. (2020) · Lund University Publications (Lund University)
Gao, S., & Dong, Y. (2021) · Brazilian Journal of Anesthesiology (English Edition) · doi:10.1016/j.bjane.2021.09.007
Herzinsuffizienz und Hypoxämie
Kramer, H. H. (2020) · Springer Reference Medizin · doi:10.1007/978-3-662-60300-0_200
Levosimendan: current and possible areas of clinical application: A review
Александрович, Б. В., Zibareva, E. I., & Ломиворотов, В. В. (2023) · Annals of critical care · doi:10.21320/1818-474x-2023-3-122-136
Postoperative Hemodynamic Assessment and Management in PCICU
Kabbani, M. S., & Altaweel, H. (2024) · Springer eBooks · doi:10.1007/978-981-99-5683-8_21
Cvetkovic, M. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-24098-0.00014-1
Koerner, T. S., Cvetkovic, M., & Corno, A. F. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-24098-0.00017-7
Feinstein, Y., Hoskote, A. U., & Pollak, U. (2025) · Springer eBooks · doi:10.1007/978-3-031-64762-8_29
Anaesthetic Management of One-Lung Ventilation in a Fontan Patient
Coulie, R., Ryckaert, F., Raevsky, E., Tsang, V. T., & Wright, S. (2025) · Cureus · doi:10.7759/cureus.89274
“An increase in PVR can be observed at high doses, and it is more arrhythmogenic compared to both dobutamine and milrinone [31].”
InfluentialMirabile, C., Benjira, Z., Zoghbi, J., & Bojan, M. (2025) · British Journal of Anaesthesia · doi:10.1016/j.bja.2025.08.058
Boillat, L., Wannaz, L., Maître, G., Rizzati, F., Marin, M. P., Amiet, V., Bernardo, S. D., & Perez, M.-H. (2026) · Clinics and Practice · doi:10.3390/clinpract16030063
“However, the lack of evidence favoring one treatment over another has led to the absence of evidence-based guidelines and a notable disparity in management practices across pediatric intensive care units (PICUs) [7–9].”
Thompson, E. J., Li, J. S., & Hornik, C. P. V. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-11851-7.00026-4
Zhang, Y., & Wu, Z. (2026) · Frontiers in Pharmacology · doi:10.3389/fphar.2026.1926005
“…a phosphodiesterase-3 inhibitor with combined inotropic and pulmonary/systemic vasodilatory properties, is the most widely used perioperative agent following arterial switch operation (ASO), employed routinely in the vast majority of pediatric cardiac centers (Roeleveld and de Klerk, 2018).”
- Authors
- Roeleveld, P. P., & de Klerk, J. C. A.
- Affiliations
- Leiden University Medical Center (NL)
- Department of Neonatal Intensive Care, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
- Corresponding author
- Roeleveld, Peter P.
- ORCID
- Roeleveld, Peter P.
- Venue
- World Journal for Pediatric and Congenital Heart Surgery
- Publisher
- SAGE Publications
- Published
- 2017-11-01
- Volume
- 9
- Issue
- 1
- Pages
- 10-21
- ISSN
- 2150-1351 (ISSN-L)
- 2150-136X
- PMC
- PMC5764149
- OpenAlex
- W2766975863
- Cited by
- 51
- References
- 90
- Citations by year
- 2026: 3 · 2025: 11 · 2024: 3 · 2023: 5 · 2022: 3 · 2021: 7 · 2020: 10 · 2019: 7 · 2018: 2
- FWCI
- 0.69
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- World Journal for Pediatric and Congenital Heart Surgery (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Keywords
- inotropic agents, low cardiac output syndrome, pediatric cardiac surgery, congenital heart surgery, postoperative care, milrinone, epinephrine, dopamine, dobutamine, levosimendan, vasopressin, corticosteroids, clinical practice variation, cardiac output monitoring, lactate monitoring, near-infrared spectroscopy, cardiac intensive care
- MeSH terms
- Animals, Cardiac Output, Cardiac Output, Low, Cardiotonic Agents, Europe, Heart Defects, Congenital, Cardiac Surgical Procedures, Humans, Pediatrics, Postoperative Care, United States, Health Care Surveys
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