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In a case report, 4 men aged 37-64 years were described, who exhibited lack of efficacy following treatment with ascorbic acid, epinephrine, hydrocortisone, hydroxocobalamin, isoprenaline, methylthioninium chloride, milrinone, nitric oxide, norepinephrine or vasopressin for hypoxia, elevated pulmonary artery pressures, vasoplegic or cardiogenic shock [not all routes and dosages stated]. Case 1: A 47-year-old man, who had end-stage heart failure secondary to hypertrophic cardiomyopathy, underwent tricuspid valve annuloplasty and orthotopic heart transplantation. His medical history included stage 3 chronic kidney disease and Staphylococcus aureus septicaemia with a retained atrial pacemaker lead. After transplantation, he required support with isoprenaline [isoproterenol] 20 ng/kg/min, epinephrine 0.03 μg/kg/min, milrinone 0.25 μg/kg/min, norepinephrine 0.04 μg/kg/min and inhaled nitric oxide 20ppm. ECG revealed mild right ventricular dysfunction and normal left ventricular function. Several hours after return from the operating room, he was persistently hypotensive with a high cardiac index of 4 L/min/m 2 . Therefore, he required escalating infusion rates of norepinephrine and redu

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Publisher

Adis International Limited (now part of Wolters Kluwer Health); Springer-Verlag; Springer Science and Business Media LLC (ISSN 0114-9954)

Published

2020

Language

EN

Field

Medicine (Health Sciences)