Incidence of milrinone blood levels outside the therapeutic range and their relevance in children after cardiac surgery for congenital heart disease.

Abstract

PURPOSE:

To evaluate whether variability in milrinone blood levels (MBL) occurs during administration to critically ill children after surgical repair of congenital heart disease, and the clinical relevance of this variability.

METHODS:

Prospective cohort study conducted in the pediatric intensive care unit of a tertiary care teaching and referral hospital. MBL were measured at three time periods after starting milrinone infusion (9-12, 18-24, 40-48 h) and at the end of the infusion. MBL were categorized as within (100-300 ng/ml) or outside the therapeutic range. Low cardiac output syndrome was defined by elevation of either lactate (>2 mmol/l) or arteriovenous oxygen difference (>30%). Five other clinical outcomes were evaluated. Regression analyses evaluated the relationships between MBL and outcomes.

RESULTS:

Sixty-three patients were included with a total of 220 MBL. Quantification of MBL was by high-performance liquid chromatography. Overall, 114 (52%) MBL were outside the therapeutic range: 78 (36%) subtherapeutic, and 36 (16%) supratherapeutic. Repeated-measures analysis found a significant association between supratherapeutic MBL and low cardiac output syndrome (p = 0.02), and supratherapeutic MBL were associated with arterial-central venous oxygen saturation difference >30% at time 3 (p = 0.007).

CONCLUSIONS:

In this cohort, nontherapeutic MBL were common. Further investigation of milrinone dosing recommendations may improve the postoperative outcomes of children.

• Authors: Gonzalo Garcia Guerra, Ari R Joffe, Ambikaipakan Senthilselvan, Demetrios J Kutsogiannis, Christopher S Parshuram
• Journal: Intensive care medicine (Intensive Care Med) Vol. 39 Issue 5 Pg. 951-7 (May 2013) ISSN: 1432-1238 [Electronic] United States
• PMID: 23435950 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Cardiotonic Agents
• Milrinone

Topics

• Cardiac Output
• Cardiac Surgical Procedures
• Cardiopulmonary Bypass
• Cardiotonic Agents (administration & dosage, blood)
• Chromatography, High Pressure Liquid
• Female
• Heart Defects, Congenital (surgery)
• Humans
• Infant
• Infant, Newborn
• Intensive Care Units, Pediatric
• Logistic Models
• Male
• Milrinone (administration & dosage, blood)
• Prospective Studies
• Regression Analysis