SNP and Nitro

Thats about what we will do in regards to Nipride and Nitro- about 4 mcg then add Nitro... but with the exception of the heart transplants, our kiddos usually have hypotension- we ususally see Milrinone, Dopa, Dobut, and Epi - then start adding norepi or vasopressin if needed.

The only kids we have on nitro are the switches, usually. And it's typically d/c'd within an hour or two of arrival. We use milrinone and nitroprusside for afterload reduction. We've maxed kids on nitroprusside at 6 mcg/kg/min. On rare occasions we've started a labetalol infusion when we can't get the desired results with nitroprusside.

For hypotension we rarely use dopamine on anyone. We use epi, norepi and vasopressin almost exclusively. All of our cardiacs are on milrinone, and some non-cardiacs too. We don't use dobutamine much anymore either. Fluid boluses are always 5 mL/kg of 5% albumin, or PRBCs if they're bleeding.