Friday August 8, 2008
Combined milrinone and enteral metoprolol therapy in septic myocardial depression

A very interesting study to counter septic cardiomyopathy.

Methods:This retrospective analysis summarizes preliminary clinical experience with the combined use of milrinone and enteral metoprolol therapy in forty patients with septic shock and cardiac depression. In all study patients, beta blockers were initiated only after stabilization of cardiovascular function in order to decrease heart rate less than 95 bpm. Hemodynamic data and laboratory parameters were extracted from medical charts and documented before, 6, 12, 24, 48, 72, and 96 hours after the first metoprolol dosage. Adverse cardiovascular events were documented.

Patients with other causes of shock or cardiac failure, patients with beta-blocker therapy initiated more than 48 hrs after shock onset and patients with pre-existent decompensated congestive heart failure were excluded.

Results

• Heart rate control (65-95 bpm) was achieved in 97.5% of patients (n=39) within 12.2+/-12.4 hrs.
• Heart rate, central venous pressure, norepinephrine, arginine vasopressin and milrinone dosages decreased.
• Cardiac index and cardiac power index remained unchanged, while stroke volume index increased
• Norepinephrine and milrinone dosages were increased in nine (22.5%) and six (15%) patients, respectively.
• PH increased, while arterial lactate, serum C-reactive protein and creatinine levels decreased during the observation period
• Twenty-eight day mortality was 33%
  

In two patients (5%) metoprolol was discontinued because of asymptomatic bradycardia

Conclusions: Low doses of enteral metoprolol in combination with phosphodiesterase inhibitors are feasible in patients with septic shock and cardiac depression but no overt heart failure.

Reference: click to get article

Combined milrinone and enteral metoprolol therapy in patients with septic myocardial depression - Critical Care 2008, 12:R99 - pdf file