Use of milrinone in pediatric intensive care units - a multicenter survey of French-speaking countries

Oct 19, 2026

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Purpose To assess the practical use of milrinone in French-speaking pediatric intensive care units. Methods A multicenter survey on milrinone therapy use was sent to pediatric intensivists, covering indications, dosage, monitoring, weaning, and side effects. Results 117 responses were received from French-speaking centers. Use was high and widespread (96.6%) across multiple cardiovascular indications, yet dosing and management practices were highly heterogeneous, with 51.3% using it at least weekly. Many reported no protocol for initiation or weaning. Conclusions Clear guidance for milrinone use in critically ill children is lacking despite frequent use; further prospective studies are needed.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Abstract

Purpose

Methods

Results

Conclusions

What is Known

What is New

Introduction

Background on cardiogenic shock

Role and pharmacology of milrinone

Regulatory approval and off-label use

French guidelines and first-choice inotrope

European Journal of Pediatrics (2025) 184:730 [https://doi.org/10.1007/s00431-025-06589-5](https://doi.org/10.1007/s00431-025-06589-5) |
RESEARCH | | | --- | --- | | | | | Use of milrinone in pediatric intensive care units: a multicenter survey of French‑speaking countries
Florian Manoeuvrier1,2 · Morgan Recher3 · Marion Grimaud1 · Sylvain Renolleau1 · Olivier Brissaud4 ·
Stéphane Leteurtre3 · Mehdi Oualha1 · Charles de Marcellus1,5 · Groupe Francophone de Réanimation et d’Urgence Pédiatriques
Received: 30 April 2025 / Revised: 8 October 2025 / Accepted: 20 October 2025 / Published online: 4 November 2025 © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2025
Abstract
Purpose To assess the practical use of milrinone in French-speaking pediatric intensive care units.
Methods A survey on milrinone therapy use, including indication, dosage, monitoring, weaning and side effects was sent to pediatric intensivists using the e-mail registry of the French-speaking Group of Pediatric Intensive Care and Emergency Medicine Network.
Results We received 117 responses from French speaking centers (response rate of 31.2%) . We observed a high and widespread use (113/117; 96.6%) of milrinone for several cardiovascular indications [right heart failure with pulmonary arterial hypertension (102/112; 91.1%), cardiogenic shock (90/112; 80.4%), decompensation of chronic heart failure (74/112; 66.1%), postoperative management of cardiac surgery (59/112; 52.7%)], with however highly heterogeneous practices on dosing, therapeutic adjustment, treatment monitoring, and weaning. More than half (60/117; 51.3%) of respondents used milrinone at least once a week. Respondents stated that approximately 25% had no protocol for either initiation or weaning No maximum duration of treatment was reported. The loading dose was rarely administered.
Conclusions There are a lack of a clear guidance and recommendations for the use of milrinone in critically ill children despite its frequent and widespread use. Further prospective studies and research are mandatory to improve and tailor milrinone use in critically ill neonates and children. | | | What is Known:
• Milrinone acts as a positive inotropic agent, reduces systemic and pulmonary vascular resistance.
• Milrinone is less arrhythmogenic and is associated with lower myocardial oxygen consumption than dobutamine.
• The use of milrinone in the postoperative management of pediatric cardiac surgery patients has been extensively studied.
What is New:
• Widespread use of milrinone in PICUs for several medical indications.
• The application of milrinone in pediatric intensive care units demonstrates great heterogeneity.
• Further prospective studies are mandatory to improve the use of milrinone in PICUs. | | A list of authors and their affiliations appears at the end of the paper. * Charles de Marcellus [charles.de-marcellus@aphp.fr](charles.de-marcellus@aphp.fr) 1 Pediatric Intensive Care Unit, AP-HP. Centre-Université de Paris. Paris, Necker-Enfants Malades, France 2 Pediatric Intensive Care Unit, CHU Amiens-Picardie, Amiens, France 3 ULR 2694-METRICS : Évaluation des technologies desanté et des pratiques médicales, Univ. Lille, CHU Lille, 59000 Lille, France 4 Pediatric Intensive Care Unit, CHU Bordeaux, Pellegrin-Enfants Hospital, Bordeaux, France 5 Réanimation et Soins Continus Médico-Chirurgicaux Pédiatriques, AP-HP CHU Necker-Enfants Malades, 149 rue de Sèvre, Paris, France Keywords Child · Milrinone · Intensive Care Units · Heart Failure · Surveys and Questionnaires Introduction Pediatric acute cardiogenic shock may result from a variety of structural or functional alterations of the heart due to congenital or acquired diseases. Despite increasing attention to the management of cardiogenic shock, mortality rates remain alarmingly high [1]. Current supportive therapy predominantly involves v

FAQs

What was the purpose of the study?

To assess the practical use of milrinone in French-speaking pediatric intensive care units.

How was the survey conducted and what topics were covered?

A survey about milrinone therapy use was emailed to pediatric intensivists and included indication, dosage, monitoring, weaning, and side effects.

What were the key findings on milrinone use and practice variability?

Milrinone use was high and widespread across several cardiovascular indications, but dosing, therapeutic adjustment, monitoring, and weaning practices were highly heterogeneous, and many respondents reported no protocol for initiation or weaning.

Oct 19, 2026

Upload by ahduag