Pilot Randomized Controlled Trial of Inhaled Milrinone in High-Risk Cardiac Surgical Patients

Abstract

A method is described for the identification of priority micropollutants (pharmaceuticals) in the aquatic environment originating from hospitals. The lack of data on the range and volume of prescribed pharmaceuticals, and on their behaviour in the environment, presented a considerable challenge to the initial selection process. The final selection of pharmaceutical substances to be included in the monitoring campaigns was based on literature data, existing priority lists, national consumption patterns and expert input from within the regions (Northwest Europe). Fifteen micropollutant compounds were identified from the diverse range of reported and prescribed pharmaceuticals in the healthcare sector: atenolol, carbamazepine, diclofenac, naproxen, lidocaine, ifosphamide, cyclophosphamide, ciprofloxacin, erythromycin, clarithromycin, sulfamethoxazole, iopromide, iopamidol, diatrizoate, and bezafibrate. Eight hospital locations in six countries were monitored for periods ranging from several weeks to one year. Samples were taken from hospital effluent (sewers) flow - proportionally and analysed by LC - MS - MS. The obtained results indicate that hospitals are significant point sources for some (especially x - ray contrast media and antibacterials) but not all pharmaceutical micropollutants. Hospital contribution to overall load in the sewers at entry to waste water treatment plants ranged from <10% for substances also used in the communities (e.g. diclofenac and atenolol), to well in excess of 50% for antibiotics and x - ray contrast media. A detailed understanding of emission pathways within the urban environment is required in order to inform related political decision making. This project demonstrated a route towards this understanding and also highlighted the difficulties and barriers that need to be overcome in the process. Keywords: