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- Title
Incidence of milrinone blood levels outside the therapeutic range and their relevance in children after cardiac surgery for congenital heart disease.
- Authors
Garcia Guerra, Gonzalo; Joffe, Ari; Senthilselvan, Ambikaipakan; Kutsogiannis, Demetrios; Parshuram, Christopher
- 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.
- Subjects
MILRINONE; CONGENITAL heart disease in children; CONGENITAL heart disease; CARDIAC surgery; CRITICAL care medicine; PHARMACOLOGY; PATIENTS
- Publication
Intensive Care Medicine, 2013, Vol 39, Issue 5, p951
- ISSN
0342-4642
- Publication type
Article
- DOI
10.1007/s00134-013-2858-3