Inhaled Milrinone via HFNC as a Postextubation Cardiopulmonary Elixir: Case Series and Review of Literature

Pulmonary hypertension (PH) often complicates perioperative course following pediatric cardiac surgery, often presenting unique challenges to the attending cardiac anesthesiologist. Apart from difficult weaning from cardiopulmonary bypass, PH can often compound weaning from mechanical ventilation in this postoperative subset. From pathophysiological standpoint, the former can be attributed to concurrent detrimental cardiopulmonary consequences of PH as a multisystemic syndrome. Therefore, with an objective to address the affected systems, that is, cardiac and pulmonary simultaneously, we report combined use of inhaled milrinone (a pulmonary vasodilator) through high-frequency nasal cannula (oxygen reservoir and continuous positive airway pressure delivery device), purported to complement each other's mechanism of action in the management of PH, thereby hastening postoperative recovery. This article additionally presents a nuanced perspective on the advantages of combining the aforementioned therapies and hence proposing the same as a possible postoperative cardiopulmonary elixir.

Shock Index in COVID Era

The health care burden and risks to health care workers imposed by novel coronavirus disease 2019 (COVID-19) mandated the need for a simple, noninvasive, objective, and parsimonious risk stratification system predicting the level of care, need for definitive airway, and titration of the ongoing patient care. Shock index (SI = heart rate/systolic blood pressure) has been evaluated in emergency triage, sepsis, and trauma settings including different age group of patients. The ever accumulating girth of evidences demonstrated a superior predictive value of SI over other hemodynamic parameters. Inclusion of respiratory and/or neurological parameters and adjustment of the cutoffs appropriate to patient age increase the predictability in the trauma and sepsis scenario. Being reproducible, dynamic, and simple, SI can be a valuable patient risk stratification tool in this ongoing era of COVID-19 pandemic.

Emergency management of cyanotic spell in a COVID-19 suspect tetralogy of Fallot child

The novel coronavirus (SARS-CoV-2) is suggested to increase the risk of morbidity and mortality in patients with underlying cardiac and pulmonary disorders. Reports of COVID-19-related multisystem inflammatory syndrome in children, past experiences with influenza virus and the respiratory syncytial virus, and British Congenital Cardiac Association recommendation on congenital heart disease warrant caution even in children. We present a case of a 2-year-old child with tetralogy of Fallot, who got admitted in the emergency with cyanotic spell and fever (suspected to be due to COVID-19), potentially compounding the challenge of managing cyanotic spell emergency. © The Authors, published by EDP Sciences, 2021.