Milrinone therapy for enterovirus 71-induced pulmonary edema and/or neurogenic shock in children: A randomized controlled trial

Chia Yu Chi, Truong Huu Khanh, Le Phan Kim Thoa, Fan Chen Tseng, Shih Min Wang, Le Quoc Thinh, Chia Chun Lin, Han Chieh Wu, Jen Ren Wang, Nguyen Thanh Hung, Tang Chi Thuong, Chung Ming Chang, Ih Jen Su, Ching Chuan Liu

研究成果: Article

24 引文 (Scopus)

摘要

OBJECTIVE:: Enterovirus 71-induced brainstem encephalitis with pulmonary edema and/or neurogenic shock (stage 3B) is associated with rapid mortality in children. In a small pilot study, we found that milrinone reduced early mortality compared with historical controls. This prospective, randomized control trial was designed to provide more definitive evidence of the ability of milrinone to reduce the 1-week mortality of stage 3B enterovirus 71 infections. DESIGN:: Prospective, unicenter, open-label, randomized, controlled study. SETTING:: Inpatient ward of a large tertiary teaching hospital in Ho Chi Minh City, Vietnam. PATIENTS:: Children (≤18 yr old) admitted with proven enterovirus 71-induced pulmonary edema and/or neurogenic shock. INTERVENTIONS:: Patients were randomly assigned to receive intravenous milrinone (0.5 μg/kg/min) (n = 22) or conventional management (n = 19). Both groups received dopamine or dobutamine and intravenous immunoglobulin. MEASUREMENTS AND MAIN RESULTS:: The primary endpoint was 1-week mortality. The secondary endpoints included length of ventilator dependence and hospital stay and adverse events. The median age was 2 years with a predominance of boys in both groups. The 1-week mortality was significantly lower, 18.2% (4/22) in the milrinone compared with 57.9% (11/19) in the conventional management group (relative risk = 0.314 [95% CI, 0.12-0.83], p = 0.01). The median duration of ventilator-free days was longer in the milrinone treatment group (p = 0.01). There was no apparent neurologic sequela in the survivors in either group, and no drug-related adverse events were documented. CONCLUSIONS:: Milrinone significantly reduced the 1-week mortality of enterovirus 71-induced pulmonary edema and/or neurogenic shock without adverse effects. Further studies are needed to determine whether milrinone might be useful to prevent progression of earlier stages of brainstem encephalitis.

原文English
頁(從 - 到)1754-1760
頁數7
期刊Critical Care Medicine
41
發行號7
DOIs
出版狀態Published - 2013 七月 1

指紋

Milrinone
Enterovirus
Pulmonary Edema
Shock
Randomized Controlled Trials
Mortality
Encephalitis
Mechanical Ventilators
Therapeutics
Brain Stem
Enterovirus Infections
Child Mortality
Dobutamine
Vietnam
Intravenous Immunoglobulins
Drug-Related Side Effects and Adverse Reactions
Tertiary Care Centers
Teaching Hospitals
Nervous System
Survivors

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

引用此文

Chi, Chia Yu ; Khanh, Truong Huu ; Thoa, Le Phan Kim ; Tseng, Fan Chen ; Wang, Shih Min ; Thinh, Le Quoc ; Lin, Chia Chun ; Wu, Han Chieh ; Wang, Jen Ren ; Hung, Nguyen Thanh ; Thuong, Tang Chi ; Chang, Chung Ming ; Su, Ih Jen ; Liu, Ching Chuan. / Milrinone therapy for enterovirus 71-induced pulmonary edema and/or neurogenic shock in children : A randomized controlled trial. 於: Critical Care Medicine. 2013 ; 卷 41, 編號 7. 頁 1754-1760.
@article{b0c01481d124465aaf0b88dfc58ca100,
title = "Milrinone therapy for enterovirus 71-induced pulmonary edema and/or neurogenic shock in children: A randomized controlled trial",
abstract = "OBJECTIVE:: Enterovirus 71-induced brainstem encephalitis with pulmonary edema and/or neurogenic shock (stage 3B) is associated with rapid mortality in children. In a small pilot study, we found that milrinone reduced early mortality compared with historical controls. This prospective, randomized control trial was designed to provide more definitive evidence of the ability of milrinone to reduce the 1-week mortality of stage 3B enterovirus 71 infections. DESIGN:: Prospective, unicenter, open-label, randomized, controlled study. SETTING:: Inpatient ward of a large tertiary teaching hospital in Ho Chi Minh City, Vietnam. PATIENTS:: Children (≤18 yr old) admitted with proven enterovirus 71-induced pulmonary edema and/or neurogenic shock. INTERVENTIONS:: Patients were randomly assigned to receive intravenous milrinone (0.5 μg/kg/min) (n = 22) or conventional management (n = 19). Both groups received dopamine or dobutamine and intravenous immunoglobulin. MEASUREMENTS AND MAIN RESULTS:: The primary endpoint was 1-week mortality. The secondary endpoints included length of ventilator dependence and hospital stay and adverse events. The median age was 2 years with a predominance of boys in both groups. The 1-week mortality was significantly lower, 18.2{\%} (4/22) in the milrinone compared with 57.9{\%} (11/19) in the conventional management group (relative risk = 0.314 [95{\%} CI, 0.12-0.83], p = 0.01). The median duration of ventilator-free days was longer in the milrinone treatment group (p = 0.01). There was no apparent neurologic sequela in the survivors in either group, and no drug-related adverse events were documented. CONCLUSIONS:: Milrinone significantly reduced the 1-week mortality of enterovirus 71-induced pulmonary edema and/or neurogenic shock without adverse effects. Further studies are needed to determine whether milrinone might be useful to prevent progression of earlier stages of brainstem encephalitis.",
author = "Chi, {Chia Yu} and Khanh, {Truong Huu} and Thoa, {Le Phan Kim} and Tseng, {Fan Chen} and Wang, {Shih Min} and Thinh, {Le Quoc} and Lin, {Chia Chun} and Wu, {Han Chieh} and Wang, {Jen Ren} and Hung, {Nguyen Thanh} and Thuong, {Tang Chi} and Chang, {Chung Ming} and Su, {Ih Jen} and Liu, {Ching Chuan}",
year = "2013",
month = "7",
day = "1",
doi = "10.1097/CCM.0b013e31828a2a85",
language = "English",
volume = "41",
pages = "1754--1760",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",
number = "7",

}

Chi, CY, Khanh, TH, Thoa, LPK, Tseng, FC, Wang, SM, Thinh, LQ, Lin, CC, Wu, HC, Wang, JR, Hung, NT, Thuong, TC, Chang, CM, Su, IJ & Liu, CC 2013, 'Milrinone therapy for enterovirus 71-induced pulmonary edema and/or neurogenic shock in children: A randomized controlled trial', Critical Care Medicine, 卷 41, 編號 7, 頁 1754-1760. https://doi.org/10.1097/CCM.0b013e31828a2a85

Milrinone therapy for enterovirus 71-induced pulmonary edema and/or neurogenic shock in children : A randomized controlled trial. / Chi, Chia Yu; Khanh, Truong Huu; Thoa, Le Phan Kim; Tseng, Fan Chen; Wang, Shih Min; Thinh, Le Quoc; Lin, Chia Chun; Wu, Han Chieh; Wang, Jen Ren; Hung, Nguyen Thanh; Thuong, Tang Chi; Chang, Chung Ming; Su, Ih Jen; Liu, Ching Chuan.

於: Critical Care Medicine, 卷 41, 編號 7, 01.07.2013, p. 1754-1760.

研究成果: Article

TY - JOUR

T1 - Milrinone therapy for enterovirus 71-induced pulmonary edema and/or neurogenic shock in children

T2 - A randomized controlled trial

AU - Chi, Chia Yu

AU - Khanh, Truong Huu

AU - Thoa, Le Phan Kim

AU - Tseng, Fan Chen

AU - Wang, Shih Min

AU - Thinh, Le Quoc

AU - Lin, Chia Chun

AU - Wu, Han Chieh

AU - Wang, Jen Ren

AU - Hung, Nguyen Thanh

AU - Thuong, Tang Chi

AU - Chang, Chung Ming

AU - Su, Ih Jen

AU - Liu, Ching Chuan

PY - 2013/7/1

Y1 - 2013/7/1

N2 - OBJECTIVE:: Enterovirus 71-induced brainstem encephalitis with pulmonary edema and/or neurogenic shock (stage 3B) is associated with rapid mortality in children. In a small pilot study, we found that milrinone reduced early mortality compared with historical controls. This prospective, randomized control trial was designed to provide more definitive evidence of the ability of milrinone to reduce the 1-week mortality of stage 3B enterovirus 71 infections. DESIGN:: Prospective, unicenter, open-label, randomized, controlled study. SETTING:: Inpatient ward of a large tertiary teaching hospital in Ho Chi Minh City, Vietnam. PATIENTS:: Children (≤18 yr old) admitted with proven enterovirus 71-induced pulmonary edema and/or neurogenic shock. INTERVENTIONS:: Patients were randomly assigned to receive intravenous milrinone (0.5 μg/kg/min) (n = 22) or conventional management (n = 19). Both groups received dopamine or dobutamine and intravenous immunoglobulin. MEASUREMENTS AND MAIN RESULTS:: The primary endpoint was 1-week mortality. The secondary endpoints included length of ventilator dependence and hospital stay and adverse events. The median age was 2 years with a predominance of boys in both groups. The 1-week mortality was significantly lower, 18.2% (4/22) in the milrinone compared with 57.9% (11/19) in the conventional management group (relative risk = 0.314 [95% CI, 0.12-0.83], p = 0.01). The median duration of ventilator-free days was longer in the milrinone treatment group (p = 0.01). There was no apparent neurologic sequela in the survivors in either group, and no drug-related adverse events were documented. CONCLUSIONS:: Milrinone significantly reduced the 1-week mortality of enterovirus 71-induced pulmonary edema and/or neurogenic shock without adverse effects. Further studies are needed to determine whether milrinone might be useful to prevent progression of earlier stages of brainstem encephalitis.

AB - OBJECTIVE:: Enterovirus 71-induced brainstem encephalitis with pulmonary edema and/or neurogenic shock (stage 3B) is associated with rapid mortality in children. In a small pilot study, we found that milrinone reduced early mortality compared with historical controls. This prospective, randomized control trial was designed to provide more definitive evidence of the ability of milrinone to reduce the 1-week mortality of stage 3B enterovirus 71 infections. DESIGN:: Prospective, unicenter, open-label, randomized, controlled study. SETTING:: Inpatient ward of a large tertiary teaching hospital in Ho Chi Minh City, Vietnam. PATIENTS:: Children (≤18 yr old) admitted with proven enterovirus 71-induced pulmonary edema and/or neurogenic shock. INTERVENTIONS:: Patients were randomly assigned to receive intravenous milrinone (0.5 μg/kg/min) (n = 22) or conventional management (n = 19). Both groups received dopamine or dobutamine and intravenous immunoglobulin. MEASUREMENTS AND MAIN RESULTS:: The primary endpoint was 1-week mortality. The secondary endpoints included length of ventilator dependence and hospital stay and adverse events. The median age was 2 years with a predominance of boys in both groups. The 1-week mortality was significantly lower, 18.2% (4/22) in the milrinone compared with 57.9% (11/19) in the conventional management group (relative risk = 0.314 [95% CI, 0.12-0.83], p = 0.01). The median duration of ventilator-free days was longer in the milrinone treatment group (p = 0.01). There was no apparent neurologic sequela in the survivors in either group, and no drug-related adverse events were documented. CONCLUSIONS:: Milrinone significantly reduced the 1-week mortality of enterovirus 71-induced pulmonary edema and/or neurogenic shock without adverse effects. Further studies are needed to determine whether milrinone might be useful to prevent progression of earlier stages of brainstem encephalitis.

UR - http://www.scopus.com/inward/record.url?scp=84880572671&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84880572671&partnerID=8YFLogxK

U2 - 10.1097/CCM.0b013e31828a2a85

DO - 10.1097/CCM.0b013e31828a2a85

M3 - Article

C2 - 23685637

AN - SCOPUS:84880572671

VL - 41

SP - 1754

EP - 1760

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 7

ER -