Nesiritide during extracorporeal membrane oxygenation

• Published in: Pediatric anesthesia Vol. 15; no. 2; pp. 152 - 157
• Main Authors: Smith, Todd, Rosen, David A., Russo, Pierantonio, Berkenbosch, John W., Gustafson, Robert A., Siu, Benjamin L., Rosen, Kathleen R., Tobias, Joseph D.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.02.2005; Blackwell
• Subjects: Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Pressure - drug effects; B‐type natriuretic peptide; Cardiopulmonary Resuscitation - methods; congenital heart disease; Dose-Response Relationship, Drug; Electrocardiography - methods; extracorporeal membrane oxygenation; Extracorporeal Membrane Oxygenation - adverse effects; Fatal Outcome; Heart Diseases - complications; Heart Diseases - therapy; Heart Ventricles - physiopathology; Hernia, Diaphragmatic - complications; Hernia, Diaphragmatic - surgery; Humans; Hypertension - complications; Hypertension - drug therapy; Hypokinesia - complications; Hypokinesia - diagnosis; Hypoplastic Left Heart Syndrome - complications; Hypoplastic Left Heart Syndrome - surgery; Infant, Newborn; Male; Medical sciences; Natriuretic Agents - therapeutic use; Natriuretic Peptide, Brain - therapeutic use; nesiritide; Respiratory Insufficiency - complications; Respiratory Insufficiency - therapy; Urination - drug effects; Diuretic; B-type natriuretic peptide; Vasodilator agent; Nesiritide; congenital heart disease; Cardiovascular disease; Anesthesia; extracorporeal membrane oxygenation; Recombinant protein; Congenital cardiopathy; Oxygenation
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1111/j.1460-9592.2004.01398.x

Summary Nesiritide is a recombinant formulation of B‐type natriuretic peptide (BNP). Preliminary experience in the adult population has shown nesiritide to be an effective agent in the treatment of decompensated congestive heart failure (CHF) in adults. Given its physiological effects, it may be an effective agent in other clinical scenarios. We report the use of nesiritide in two infants during extracorporeal membrane oxygenation (ECMO). In one patient, nesiritide in doses up to 0.09 μg·kg−1·min−1 were used to control mean arterial pressure while in the other patient, doses of 0.01–0.03 μg·kg−1·min−1 were used to augment urine output. The potential applications of nesiritide and dosing regimens for this agent in the ECMO population are discussed.