Milrinone improves lung compliance in patients receiving mechanical ventilation for cardiogenic pulmonary edema.
BACKGROUND
Cardiogenic pulmonary edema is a frequent cause of respiratory failure. We investigated whether milrinone improved lung compliance.


METHODS
We selected 10 patients with respiratory failure due to severe cardiogenic pulmonary edema to receive mechanical ventilation. Patients were administered a bolus injection of milrinone (50 microg kg-1) over 10 min, followed by continuous intravenous infusion (0.5 microg kg-1 min-1). Lung compliance, blood gas values, hemodynamic parameters, and sample plasma milrinone levels were assessed over 120 min after the onset of the continuous infusion of milrinone.


RESULTS
Ten min following milrinone infusion, dynamic compliance (Cdyn) and static compliance (Cst) increased from 37 +/- 12 to 42 +/- 12 ml cmH2O-1 and from 40 +/- 13 to 45 +/- 12 ml cmH2O-1, respectively (P < 0.01). Plasma milrinone levels reached a therapeutic level for vasodilator and positive inotropic effect at 10 min after milrinone infusion. A significant decrease in mean pulmonary artery pressure and pulmonary artery wedge pressure occurred simultaneously with an increase in respiratory system compliance. However, an increase in cardiac index was observed later than these changes. There were significant correlations between the mean pulmonary artery pressure and Cdyn (r = -0.39, P < 0.01) and Cst (r = -0.38, P < 0.01).


CONCLUSIONS
Milrinone-induced improvement in lung compliance along with an improvement of hemodynamics was found together with an inverse relationship between compliance and mean pulmonary artery pressure.
Takeda
S
S
Department of Intensive Care Medicine, Nippon Medical School, Tokyo, Japan. shinhiro@nms.ac.jp
Matsumura
J
J
Ikezaki
H
H
Kim
C
C
Sato
N
N
Nakanishi
K
K
Sakamoto
A
A
Ogawa
R
R
Tanaka
K
K
D000368:Aged; D001784:Blood Gas Analysis; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007262:Infusions, Intravenous; D008170:Lung Compliance / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D011654:Pulmonary Edema / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D012121:Respiration, Artificial; D012129:Respiratory Function Tests; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*
D014665:Vasodilator Agents; D020105:Milrinone