Title: Clinical observations on the use of phosphodiesterase inhibitors as second-line inotropes in septic shock
Abstract: Objective: To document the effects of the phosphodiesterase inhibitors, enoximone and milrinone, on haemodynamics and oxygen transport in severe septic shock. Design: Retrospective. Setting: University hospital intensive care unit. Patients: Ten patients with severe septic shock who failed to meet therapeutic goals with conventional therapy. Interventions: Full haemodynamic and oxygen transport profiles of patients before and after administration of either enoximone (seven patients) or milrinone (three patients). The doses of other inotropes were also adjusted to achieve clinical goals. Measurements and results: Cardiac index increased from 2.8 (1.2-3.5) to 4.2 (2.3-5.6) l/min/M2 (median; range); DO2I from 409 (195-549) to 610 (373-747) ml/min/M2. SVR fell from 1,319 (586-2,283) to 858 (464-2,357) dyne.sec/cm5. There were no other statistically nor clinically significant changes. MAP tended to fall, but was easily restored by the use of fluid and/or vasoconstrictors. Conclusions: Enoximone and milrinone can be used to increase cardiac output in patients with septic shock who are unresponsive to increasing doses of catecholamines. In this small group of patients no serious adverse effects were seen. However, prospective, controlled studies with larger numbers of patients are required to establish the place of these agents.
Publication Year: 1997
Publication Date: 1997-02-01
Language: en
Type: article
Indexed In: ['crossref']
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