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01-05-2013 | Pediatric Original

Incidence of milrinone blood levels outside the therapeutic range and their relevance in children after cardiac surgery for congenital heart disease

Authors: Gonzalo Garcia Guerra, Ari R. Joffe, Ambikaipakan Senthilselvan, Demetrios J. Kutsogiannis, Christopher S. Parshuram

Published in: Intensive Care Medicine | Issue 5/2013

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.

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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: Gonzalo Garcia Guerra
Ari R. Joffe
Ambikaipakan Senthilselvan
Demetrios J. Kutsogiannis
Christopher S. Parshuram
Publication date: 01-05-2013
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 5/2013
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-013-2858-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Incidence of milrinone blood levels outside the therapeutic range and their relevance in children after cardiac surgery for congenital heart disease

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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