Key result
Early milrinone infusion without a loading dose improved cardiac index and mean arterial pressure, and decreased mean pulmonary arterial pressure compared to a loading dose regimen (P<0.05).
Why the study?
The study was conducted to compare the effects of two different dosing regimens of milrinone in pediatric patients with pulmonary artery hypertension undergoing corrective cardiac procedures.
Does early milrinone infusion without a loading dose improve hemodynamics and clinical outcomes compared to a loading dose regimen in pediatric patients with PAH undergoing corrective cardiac surgery?
RCT (n=100)
Does early milrinone infusion without a loading dose improve hemodynamics and clinical outcomes compared to a loading dose regimen in pediatric patients with PAH undergoing corrective cardiac surgery?
Early initiation of milrinone infusion without a loading dose improves hemodynamics and reduces ICU and hospital length of stay in pediatric patients with PAH undergoing corrective cardiac surgery.
Background : The aim of the study was to compare the effect of two different regimens of milrinone in pediatric patients with pulmonary artery hypertension (PAH) undergoing corrective procedure. Materials and Methods : This randomized prospective study included 100 pediatric patients undergoing corrective cardiac surgeries. Group E: Milrinone was started as infusion 0.5 μg/kg/min without a loading dose after induction of anesthesia and continued as infusion 0.5–0.75 μg/kg/min in the pediatric cardiac surgical intensive care unit (PSICU). Group L: Milrinone was started as a loading dose 50 μg/kg over 10 min before weaning from cardiopulmonary bypass (CPB) followed by infusion 0.5–0.75 μg/kg/min in the PSICU. We compared heart rate, mean arterial blood pressure, central venous pressure, cardiac index (CI), mean pulmonary arterial pressure (MPAP), serum lactate level, urine output, vasoactive inotropic score, mechanical ventilation duration, and intensive care unit (ICU)- and hospital length of stay between the groups. Results : There was an increase in mean arterial blood pressure, CI, and urine output in Group E compared to Group L ( P < 0.05). MPAP, serum lactate level, and requirement of inotropes and vasopressors were lower in Group E compared to Group L ( P < 0.05). Mechanical ventilation duration, ICU, and hospital length of stay were shorter in Group E than Group L ( P < 0.05). Conclusions : Early use of milrinone in patients with PAH undergoing corrective cardiac surgeries improved CI and mean arterial pressure, decreased MPAP, improved urine output, decreased serum lactate level, and decreased requirement of inotropes and vasopressors after weaning from CPB compared to the milrinone bolus group.
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Prajapati et al. (2022) conducted an RCT in Pulmonary artery hypertension (n=100). Milrinone early infusion vs. Milrinone loading dose (50 μg/kg over 10 min) followed by infusion was evaluated on Hemodynamic parameters, serum lactate, urine output, vasoactive inotropic score, mechanical ventilation duration, and length of stay (p=< 0.05). Early milrinone infusion without a loading dose improved cardiac index and mean arterial pressure, and decreased mean pulmonary arterial pressure compared to a loading dose regimen (P<0.05).
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