Milrinone Therapy for Enterovirus 71-Induced Pulmonary Edema and/or Neurogenic Shock in Children
Autor: | Ching Chuan Liu, Chung Ming Chang, Le Phan Kim Thoa, Fan-Chen Tseng, Le Quoc Thinh, Tang Chi Thuong, Han Chieh Wu, Chia Chun Lin, Nguyen Thanh Hung, Shih Min Wang, Truong Huu Khanh, Chia Yu Chi, Ih-Jen Su, Jen Ren Wang |
---|---|
Rok vydání: | 2013 |
Předmět: |
Male
Cardiotonic Agents Dopamine Immunoglobulins Pulmonary Edema Neurogenic shock Critical Care and Intensive Care Medicine medicine.disease_cause law.invention Randomized controlled trial law Dobutamine Enterovirus Infections medicine Enterovirus 71 Humans Prospective Studies Stage (cooking) Infusions Intravenous biology business.industry Infant Shock Length of Stay medicine.disease Pulmonary edema biology.organism_classification Respiration Artificial Brainstem encephalitis Vietnam Child Preschool Anesthesia Enterovirus Milrinone Female business medicine.drug |
Zdroj: | Critical Care Medicine. 41:1754-1760 |
ISSN: | 0090-3493 |
Popis: | Enterovirus 71-induced brainstem encephalitis with pulmonary edema and/or neurogenic shock (stage 3B) is associated with rapid mortality in children. In a small pilot study, we found that milrinone reduced early mortality compared with historical controls. This prospective, randomized control trial was designed to provide more definitive evidence of the ability of milrinone to reduce the 1-week mortality of stage 3B enterovirus 71 infections.Prospective, unicenter, open-label, randomized, controlled study.Inpatient ward of a large tertiary teaching hospital in Ho Chi Minh City, Vietnam.Children (≤ 18 yr old) admitted with proven enterovirus 71-induced pulmonary edema and/or neurogenic shock.Patients were randomly assigned to receive intravenous milrinone (0.5 μg/kg/min) (n = 22) or conventional management (n = 19). Both groups received dopamine or dobutamine and intravenous immunoglobulin.The primary endpoint was 1-week mortality. The secondary endpoints included length of ventilator dependence and hospital stay and adverse events. The median age was 2 years with a predominance of boys in both groups. The 1-week mortality was significantly lower, 18.2% (4/22) in the milrinone compared with 57.9% (11/19) in the conventional management group (relative risk = 0.314 [95% CI, 0.12-0.83], p = 0.01). The median duration of ventilator-free days was longer in the milrinone treatment group (p = 0.01). There was no apparent neurologic sequela in the survivors in either group, and no drug-related adverse events were documented.Milrinone significantly reduced the 1-week mortality of enterovirus 71-induced pulmonary edema and/or neurogenic shock without adverse effects. Further studies are needed to determine whether milrinone might be useful to prevent progression of earlier stages of brainstem encephalitis. |
Databáze: | OpenAIRE |
Externí odkaz: |