The following is a summary of “Systemic tolerance of intravenous milrinone administration for cerebral vasospasm secondary to non-traumatic subarachnoid hemorrhage,” published in the April 2024 issue of Critical Care by Julian et al.
In prior studies of subarachnoid hemorrhage (SAH), researchers investigated intravenous milrinone to treat cerebral vasospasm (CVS), a complication that can lead to delayed cerebral ischemia (DCI).
Researchers conducted a retrospective study describing the effects of milrinone on heart function (hemodynamic), breathing (respiratory), and kidney function (renal) in patients receiving it for CVS.
They involved patients who received intravenous milrinone for CVS and monitored systemic hemodynamics, oxygenation, and renal disorders. The study tracked the evolution of parameters before and after milrinone initiation (day 1, baseline, day 1, and day 2), identified reasons for treatment cessation, and evaluated neurological outcomes at 3–6 months.
The results showed 91 patients. Milrinone initiation increased cardiac output (4.5 liters per minute [3.4–5.2] at baseline vs. 6.6 liters per minute [5.2–7.7] at day 2, P< 0.001), a decrease in Mean Arterial Pressure (101 mmHg [94–110] at baseline vs. 95 mmHg [85–102] at day 2, P=0.001), an increase in norepinephrine treatment requirement (32% of patients before milrinone start vs. 58% at day 1, P=0.002), and a slight deterioration in PaO2/FiO2 ratio (401 [333–406] at baseline vs. 348 [307–357] at day 2, P=0.016). Milrinone was interrupted in 8% of patients. Fifty-five percent had a favorable outcome.
Investigators concluded that intravenous milrinone for CVS treatment often caused substantial changes in overall body circulation (hemodynamics), sometimes requiring doctors to stop the treatment.
Source: sciencedirect.com/science/article/pii/S0883944124002946