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Milrinone modulates endotoxemia, systemic inflammation, and subsequent acute phase response after cardiopulmonary
T Möllhoff1, H M Loick, H Van Aken
1Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Westfälische Westfälische Wilhelms-Universität Münster, Germany. thomas.moellhoff@uni-muenster.de
Background:
Compromised splanchnic perfusion and the resulting intestinal mucosal injury leads to a decreased mucosal barrier function, which allows translocation of intestinal flora and endotoxemia. The authors evaluated the effects of milrinone on splanchnic oxygenation, systemic inflammation, and the subsequent acute-phase response in patients undergoing coronary artery bypass grafting.
Methods:
This open, placebo-controlled randomized clinical study enrolled 22 adult patients in two groups. Before induction of anesthesia, baseline values were obtained and patients were randomized to receive milrinone (30 microg/kg bolus administered progressively in 10 min, followed by a continuous infusion of 0.5 microg x kg(-1) x min(-1)) or saline. The following parameters were determined: hemodynamics; systemic oxygen delivery and uptake; arterial, mixed venous and hepatic venous oxygen saturation; intramucosal pH (pHi); and mixed and hepatic venous plasma concentrations of endotoxin, interleukin 6, serum amyloid A, and C-reactive protein.
Results:
Milrinone did not prevent gastrointestinal acidosis as measured by pHi, but its perioperative administration resulted in significantly higher pHi levels compared with control. Venous and hepatic venous endotoxin and the interleukin 6 concentration were reduced significantly in the milrinone group. Serum amyloid A values were attenuated in the milrinone group 24 h after surgery. No significant differences could be seen in routinely measured oxygen transport-derived variables.
Conclusions:
Perioperative administration of low-dose milrinone may have antiinflammatory properties and may improve splanchnic perfusion in otherwise healthy patients undergoing routine coronary artery bypass grafting.
Insights
Low-dose milrinone improved splanchnic perfusion and reduced inflammation during coronary artery bypass grafting. While not preventing acidosis, it enhanced intramucosal pH and lowered endotoxin and interleukin-6 levels, suggesting anti-inflammatory benefits.
Area of Science:
- Cardiovascular Surgery
- Critical Care Medicine
- Pharmacology
Background:
- Splanchnic hypoperfusion and intestinal injury compromise mucosal barrier function, leading to bacterial translocation and endotoxemia.
- Coronary artery bypass grafting (CABG) patients are susceptible to compromised splanchnic perfusion.
- Evaluating milrinone's impact on splanchnic oxygenation and inflammation in CABG is crucial.
Purpose of the Study:
- To assess the effects of perioperative milrinone on splanchnic oxygenation and systemic inflammation.
- To evaluate the impact of milrinone on the acute-phase response in patients undergoing CABG.
Main Methods:
- An open, placebo-controlled randomized clinical study involving 22 adult patients undergoing CABG.
- Patients received either a milrinone bolus and infusion or a saline placebo.
- Hemodynamics, oxygen transport, intramucosal pH (pHi), and plasma concentrations of endotoxin, interleukin-6, serum amyloid A, and C-reactive protein were measured.
Main Results:
- Milrinone administration led to significantly higher intramucosal pH (pHi) levels compared to the control group.
- Significant reductions in venous and hepatic venous endotoxin and interleukin-6 concentrations were observed in the milrinone group.
- Serum amyloid A levels were attenuated at 24 hours post-surgery in the milrinone group, though routine oxygen transport variables showed no significant differences.
Conclusions:
- Perioperative low-dose milrinone may possess anti-inflammatory properties.
- Milrinone may improve splanchnic perfusion in patients undergoing routine CABG.
- Further research is warranted to fully elucidate milrinone's role in mitigating perioperative inflammation and improving outcomes in cardiac surgery.