The following is a summary of the “Home Milrinone in Pediatric Hospice Care of Children with Heart Failure,” published in the February 2023 issue of Pain and Symptom Management by Hollander, et al.
When compared to children who die from cancer or other non-cardiac causes, those who die from cardiac disease, especially heart failure, have a unique set of symptoms. As an alternative to the standard pain and anxiety management with morphine and benzodiazepines, home vasoactive infusion therapy may be more effective in helping these patients manage their symptoms. Here, the researchers share their knowledge of administering milrinone as an outpatient to kids with terminal heart failure in a hospice setting.
Analysis of a prospective cohort of all children treated with intravenous milrinone and released from Stanford’s Lucile Packard Children’s Hospital between 2008 and 2021. Cardiac diagnosis, milrinone dose, route of administration, total milrinone days, symptoms, rehospitalization rates, concomitant therapies, and complications were all examined. The longest period of care for 8 patients receiving home milrinone infusions was 1,054 days. At the time of their deaths, all patients were also taking diuretics. By the time they reached the terminal phase, 5 (63%) had not been given any additional pain medication.
Patients’ reports of respiratory discomfort, abdominal pain, weight loss/lack of appetite, and fatigue decreased from when milrinone was first administered until the most recent outpatient assessment. The 6 of the 8 (75% of the total) fatalities occurred in the residence. In children with heart failure receiving palliative care, the researchers found that the combination of milrinone and oral diuretics was effective in managing their symptoms. Based on their observations, this mixture does not require the addition of opiates, benzodiazepines, or supplemental oxygen when used for extended periods of time in the outpatient setting.