Milrinone Use Linked to Higher Mortality in Pediatric Septic Shock Cohort

Researchers reviewed records from two tertiary-care pediatric intensive care units in France, including patients aged 1 month to 18 years with fluid-refractory septic shock who received at least one vasoactive or inotropic agent from May 2011 to April 2021. The cohort included 290 children; 46 (16%) received milrinone, at a median dose of 0.5 µg/kg/min. The investigators compared survival, organ support, length of stay, and adverse events between groups.

Overall mortality was 19% (55/290). Milrinone use was associated with a higher hazard of 30-day mortality (HR 2.57; 95% CI 1.15–5.75; p=0.021). Compared with children not given milrinone, those receiving it had more cardiac arrests in the PICU (22/46 vs 28/244) and more reported adverse events (17/46 vs 24/244). They also received greater fluid-bolus volumes and were more often mechanically ventilated.

Because this was a retrospective comparison, these associations do not show that milrinone caused worse outcomes. Differences in illness severity or other factors influencing treatment selection may have contributed. The findings describe outcomes in two centers over a 10-year period and do not establish whether milrinone should be used in other clinical settings.