Adjunctive Milrinone for Septic Shock
Trial question
What is the effect of adjunctive milrinone on hemodynamics in patients with septic shock?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
53.0% female
47.0% male
N = 64
64 patients (34 female, 30 male).
Inclusion criteria: adult patients with septic shock, adequate fluid resuscitation, and a mean arterial pressure ≥ 65 mmHg.
Key exclusion criteria: CKD stage 5 and denial of RRT; life-threatening tachyarrhythmia before enrolment; DNR; terminal illness.
Interventions
N=32 milrinone (20 mg IV in 100 mL normal saline solution at a rate of 0.5 mg/kg/min for up to 12 hours).
N=32 placebo (100 mL of normal saline solution prepared identically).
Primary outcome
Median improvement in cardiac output at 6 hours
0.62 L/min
0.13 L/min
0.6 L/min
0.5 L/min
0.3 L/min
0.2 L/min
0.0 L/min
Milrinone
Placebo
Significant
increase ▲
Significantly greater improvement in median cardiac output at 6 hours (0.62 L/min vs. 0.13 L/min; MD 0.49, 95% CI 0.01 to 0.97).
Secondary outcomes
Significantly greater improvement in median cardiac index (22.5% vs. 4.4%; MD 18.1, 95% CI 0.71 to 35.49).
No significant difference in death in the hospital (56.3% vs. 53.1%; AD 3.2%, 95% CI -20.34 to 26.74).
No significant difference in median ICU length of stay (10 days vs. 15 days; AD -5 days, 95% CI -14.68 to 4.68).
Safety outcomes
No significant difference in adverse events.
Conclusion
In adult patients with septic shock, adequate fluid resuscitation, and a mean arterial pressure ≥ 65 mmHg, milrinone was superior to placebo with respect to median improvement in cardiac output at 6 hours.
Reference
Surat Tongyoo, Suratee Chobngam, Nutnicha Yolsiriwat et al. Effects of adjunctive milrinone versus placebo on hemodynamics in patients with septic shock: a randomized controlled trial. Ann Med. 2025 Dec;57(1):2484464.
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