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The effect of milrinone on hemodynamic and gas exchange parameters in children
Rohit S Loomba1,2, Vincent Dorsey1, Enrique G Villarreal3,4
1Cardiology, Pediatrics, Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, IL, USA.
Insights
Milrinone improves cardiac output and reduces pressure in critically ill children. This drug offers beneficial hemodynamic effects in pediatric critical care when administered at standard doses.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiovascular Pharmacology
- Hemodynamics
Background:
- Milrinone is utilized for hemodynamic support in critically ill children.
- The physiological basis for milrinone's effects in pediatric patients is not well understood.
- Understanding these effects is crucial for optimizing treatment strategies.
Purpose of the Study:
- To systematically review and characterize the hemodynamic effects of milrinone in critically ill children.
- To consolidate existing evidence on milrinone's impact on pediatric hemodynamics.
Main Methods:
- A systematic review was performed, including studies with pre- and post-milrinone hemodynamic data in pediatric patients.
- Studies were quality-assessed, and only those focused on children in critical illness were included.
- Six studies involving 791 patients met the inclusion criteria.
Main Results:
- Milrinone administration resulted in increased cardiac output and left ventricle shortening fraction.
- A decrease in right ventricular systolic pressure and serum lactate levels was observed.
- No significant changes were noted in systolic blood pressure, mean arterial blood pressure, or arterial oxygen concentration.
Conclusions:
- Milrinone demonstrates significant beneficial hemodynamic effects in children experiencing critical illness.
- These positive effects are consistent across various clinical scenarios and standard dosing regimens.
- The findings support the use of milrinone for hemodynamic support in pediatric critical care.
Abstract:
Milrinone is a drug frequently used for hemodynamic support in children during critical illness. Although the hemodynamic changes induced by milrinone in children may appear similar to those of adults, the physiologic contributors of these changes remain vastly unknown. A systematic review was conducted to identify studies characterising the hemodynamic effects of milrinone in children during critical illness for hemodynamic support for various medical conditions. Studies were assessed for quality and those of satisfactory quality with pre- and post-operative hemodynamics for each patient were included in the final analyses. Those not limited to children and those not limited to patients with critical illness were excluded from the final analyses. A total of six studies with 791 patients were included in the final analyses. Milrinone infusion doses ranged from 0.3 to 0.75 mcg/kg/minute with the mean infusion dose being 0.5 mcg/kg/minute. Patients whom received milrinone infusion had greater cardiac output, greater left ventricle shortening fraction, lower right ventricular systolic pressure, and lower serum lactate levels. Systolic blood pressure mean arterial blood pressure and arterial oxygen concentration did not significantly change with administration of milrinone. These results were irrespective of milrinone infusion dose, infusion duration, and study size. Milrinone was found to have several beneficial hemodynamic effects in children during critical illness when used at usual clinical doses.
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