IV milrinone for cardiac output increase and maintenance: comparison in nonhyperdynamic SIRS sepsis and congestive heart failure

Objective: To characterize the effect of the phosphodiesterase inhibitor (P DEI) milrinone in adult patients with a non-hyperdynamic condition during t he course of the systemic inflammatory response syndrome (SIRS) or sepsis w hen compared with patients with congestive heart failure (CHF), PDEIs are p otent inhibitors of cytokine production and expression, We hypothesized tha t there might be an outstanding beneficial effect of PDEIs in the setting o f SIRS/sepsis, Design: Prospective, open labeled, protocol-driven pilot study. Patients: Nine patients with a non-hyperdynamic hemodynamic condition durin g SIRS/sepsis (group 1) and seven patients with CHF (group 2) requiring ino tropic support, All patients were having heart disease. All patients had a combination of various catecholamines at the time of inclusion in the study and had received fluid resuscitation to an extent that left ventricular st roke work index (LVSWI) did not increase further. Intervention: Milrinone infusion at a rate of 0.5 mu g/kg per min in additi on to preexisting catecholamine therapy. Measurement and results: Measurements of cardiac index (CI; thermodilution) and calculation of vascular resistance and LVSWI was done every 8 h for at least 40 h during milrinone infusion, CI and LVSWI significantly increased in both groups (p < 0.001 and P = 0.006, respectively), There were no sign ificant differences between groups in these parameters (p > 0.11 and p > 0. 13, respectively). The LVSWI increase occurred while there was a decrease i n pulmonary capillary wedge pressure, suggesting a true and comptuable impr ovement in cardiac function relatively independent of loading conditions, P reexisting catecholamines had to be increased in both groups (NS), Milrinon e had to be discontinued in one patient due to hypotension. Conclusion: Milrinone administration is feasible in selected patients with a non-hyperdynamic condition during SIRS/hepsis and with preexisting heart disease, Under the conditions of this study, milrinone was no better in ter ms of CI and LVSWI maintenance in septic cardiac dysfunction when compared with CHE These results do not necessarily extend to other cohorts with no p reexisting heart disease.