Use of milrinone in pediatric intensive care units: a multicenter survey of French-speaking countries.

PURPOSE: To assess the practical use of milrinone in French-speaking pediatric intensive care units.

METHODS

A survey on milrinone therapy use, including indication, dosage, monitoring, weaning and side effects was sent to pediatric intensivists using the e-mail registry of the French-speaking Group of Pediatric Intensive Care and Emergency Medicine Network.

RESULTS

We received 117 responses from French speaking centers (response rate of 31.2%). We observed a high and widespread use (113/117; 96.6%) of milrinone for several cardiovascular indications [right heart failure with pulmonary arterial hypertension (102/112; 91.1%), cardiogenic shock (90/112; 80.4%), decompensation of chronic heart failure (74/112; 66.1%), postoperative management of cardiac surgery (59/112; 52.7%)], with however highly heterogeneous practices on dosing, therapeutic adjustment, treatment monitoring, and weaning. More than half (60/117; 51.3%) of respondents used milrinone at least once a week. Respondents stated that approximately 25% had no protocol for either initiation or weaning. No maximum duration of treatment was reported. The loading dose was rarely administered.

CONCLUSIONS

There are a lack of a clear guidance and recommendations for the use of milrinone in critically ill children despite its frequent and widespread use. Further prospective studies and research are mandatory to improve and tailor milrinone use in critically ill neonates and children.

WHAT IS KNOWN: • Milrinone acts as a positive inotropic agent, reduces systemic and pulmonary vascular resistance. • Milrinone is less arrhythmogenic and is associated with lower myocardial oxygen consumption than dobutamine. • The use of milrinone in the postoperative management of pediatric cardiac surgery patients has been extensively studied.

WHAT IS NEW: • Widespread use of milrinone in PICUs for several medical indications. • The application of milrinone in pediatric intensive care units demonstrates great heterogeneity. • Further prospective studies are mandatory to improve the use of milrinone in PICUs.