Milrinone therapy in catecholamine-dependent critically ill patients with heart failure

Background: Treatment with the PDE-III inhibitor milrinone improves hemodyn amics in patients with heart failure. We examined whether therapy with milr inone is safe and effective in critically ill patients with catecholamine-d ependent heart failure and whether treatment with milrinone facilitates wea ning from prolonged catecholamine therapy. Methods: Twenty adult patients with reduced left ventricular function and p rolonged (7+/-4 days) catecholamine therapy in whom attempts at catecholami ne weaning had failed were examined. Patients were prospectively randomised either to group A (addition of a fixed dose of 0.5 mu g.kg(-1).min(-1) mil rinone to catecholamine therapy) or to group B (continued catecholamine the rapy without milrinone). Dobutamine and norepinephrine treatment and fluid intake were titrated according to predefined hemodynamic goals. Hemodynamic parameters, fluid requirements and catecholamine dose were monitored. Results: After 24 h of study treatment goup A showed a significant increase in cardiac index (2.2+/-0.4 1 min(-1).m(-2) to 2.7+/-0.5 l min(-1).m(-2); P<0.005), a decrease in systemic vascular resistance (1427+/-609 dyn.s.cm(- 5) to 951+/-184 dyn.s.cm(-5); P<0.005), required lower doses of dobutamine (5.9+/-4.2 mu g.kg(-1).min(-1) to 2.2+/-3.3 mu g.kg(-1).min(-1); P<0.02), b ut showed a tendency for higher vasoconstrictor (0.14+/-0.16 mu g.kg(-1).mi n(-1) to 0.29+/-0.43 mu g.kg(-1).min(-1); P=n.s.) and fluid requirements (1404+/-2257 ml/24 h to +-2508+/-1873 ml/24 h; P=n.s.). No significant chang es occurred in group B. Weaning from catecholamine therapy was more often a chieved in group A and more milrinone treated patients were discharged aliv e from the ICU (80% vs. 30%; P<0.05). Conclusions: Milrinone improves central hemodynamics and may facilitate wea ning from prolonged catecholamine support in critically ill patients with h eart failure. Its administration in this subset of critically ill patients is safe, but eventually is associated with additional vasoconstrictor and f luid requirements. (C) Acta Anaesthesiologica Scandinavica 44 (2000).