Milrinone role in treatment of septic shock

Introduction

The inotropic agents used in the ICU are dobutamine and milrinone; unfortunately, they have shown significant side effects when used for myocardial depression during septic shock. Our objective is to describe Mn behavior in septic shock.

Methods

We reviewed 72 clinical records of patients with diagnosis of septic and mixed shock who received Mn through January to December 2013. Demographic, hemodynamic, metabolic and gasometric data were recorded before and after Mn infusion. The PiCCO monitoring system was used. Data were expressed as mean and standard deviation. The statistical analysis used Student's t test. P < 0.05 was considered significant.

Results

Seventy-two patients were studied: 36.5% were women, mean and SD of age, APACHE II, mechanical ventilation days and long ICU stay were: 67 ± 16 years, 18.5 ± 5.9 points, 14.9 ± 12.9 and 24.5 ± 21.9 days, respectively. A total 20.3% of the patients received dobutamine. Thirty-nine percent presented mixed shock. Global mortality was 23%. After Mn infusion: cardiac index (CI) increased: 3.1 ± 1 to 3.3 ± 1.1, cardiac rate increased: 82.4 ± 14.4 to 88.3 ± 18 and ScvO₂ increased: 71.1 ± 10.3 to 76.1 ± 7.3 (P < 0.05). PaCO₂ arteriovenous difference and lactate were reduced: 7.36 ± 3.3 to 6.04 ± 3.6 and 18.7 ± 14.9 to 13.1 ± 9.1 (P < 0.05). CVP, MAP, RVSI, VSTI, EVLWI and base excess showed no significant difference. Mn initial average dose was 0.35 ± 0.13. NE before and after Mn infusion showed no significant difference: 0.11 ± 0.20 versus 0.12 ± 0.22.

Conclusion

Mn optimizes cardiovascular performance in septic shock and mixed shock, without affecting hemodynamic variables and global tissue perfusion. In addition, we observed that the IC, ScvO₂, PaCO₂ arteriovenous difference and lactate are related variables.