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Therapeutic efficacy of milrinone in the management of enterovirus 71‐induced pulmonary edema
Author(s) -
Wang ShihMin,
Lei HuanYao,
Huang MeiChih,
Wu JingMin,
Chen ChunTa,
Wang JiehNeng,
Wang JenRen,
Liu ChingChuan
Publication year - 2005
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.20157
Subject(s) - milrinone , medicine , pulmonary edema , gastroenterology , enterovirus 71 , edema , anesthesia , heart failure , lung , immunology , enterovirus , virus
Hand, foot, and mouth disease and herpangina are the major clinical manifestations of enterovirus 71 (EV71) infections. Brain‐stem encephalitis and pulmonary edema are severe complications that can lead to death. This study was designed to evaluate the potential therapeutic effect of milrinone, a phosphodiesterase (PDE) inhibitor, in the treatment of patients with EV71‐induced pulmonary edema. We conducted a historically controlled trial of 24 children with severe EV71‐induced pulmonary edema from April 1998–June 2003 in southern Taiwan. Patients were divided into groups treated before and after the introduction of milrinone therapy. Etiological diagnosis was established by viral cultures and confirmed by specific immunofluorescence and neutralization tests. All 24 patients were below 5 years of age. The mortality was lower in the milrinone‐treated vs. nontreated group (36.4% vs. 92.3%, P = 0.005). Sympathetic tachycardia was decreased in patients treated with milrinone compared to controls (144 ± 17/min vs. 206 ± 26/min, P = 0.004). A marked decrease in IL‐13 (77 ± 9 pg/ml vs. 162 ± 88 pg/ml, P = 0.001) was observed in milrinone‐treated patients compared to controls. There was a significant reduction in white blood cell (10,838 ± 4,537/mm 3 vs. 19,475 ± 7,798/mm 3 , P = 0.009) and platelet (257 ± 45 × 10 3 /mm 3 vs. 400 ± 87 × 10 3 /mm 3 , P = 0.001) counts in milrinone‐treated patients compared to controls. These results were associated with improvement in sympathetic regulation and decrease in IL‐13 production. Milrinone therapy may provide a useful therapeutic approach for this highly lethal disorder. Pediatr Pulmonol. 2005; 39:219–223. © 2005 Wiley‐Liss, Inc.