milrinone

INTRODUCTION

Milrinone is a potent selective inhibitor of type III phosphodiesterase. It is used to improve cardiac output by inotropic effect and reduction of afterload. In addition, milrinone may improve myocardial relaxation between contractions. Milrinone is used as a first-line agent for children who have undergone cardiac surgery for prevention of low cardiac output syndrome and as second-line therapy for children with vasoconstriction septic shock.

A clear relationship between the dose or plasma concentration of milrinone and its efficacy or toxicity in children has yet to be defined, because of limitations and inconsistencies in the existing pharmacokinetic literature. The adverse effects of milrinone include sinus tachycardia, arrhythmia, hypotension requiring vasopressor therapy, gastrointestinal upset (feed intolerance, bleeding, vomiting, and diarrhea), and central nervous system disturbance (agita­tion and seizures). The half-life of milrinone was about 2 h in healthy adult volunteers but was prolonged in patients with renal impairment, in infants younger than 1 year, and in neonates. Dose adjustment is recommended for these groups.

At The Hospital for Sick Children in Toronto, Ontario, the loading dose for milrinone (at the time of study) was 50 Fg/kg, and 3 options were available for maintenance therapy: 0.33, 0.66, and 0.99 Fg/kg per minute. No modifications were recommended to address patient-specific factors such as age or renal function. In the literature, the dosing recommendations for children include initial loading dose of 50 Fg/kg to 75 Fg/kg, followed by infusion at a rate of 0.5 Fg/kg per minute up to 1 Fg/kg per minute. Viagra Professional

Given the vulnerability of the population requiring milri- none and the frequency of renal dysfunction in critically ill children, this study was performed to determine dosing practices for and clinical outcomes of children receiving milrinone. The primary objective was to describe milrinone use in critically ill children. The secondary objective was to explore the association between milrinone dosing and the proportion of patients experiencing low cardiac output syndrome (despite milrinone therapy) or adverse drug-related events.