asneakyseal

Patient seemed pretty euvolemic - despite the CVP. What we ended up doing was giving 250 of 5% Albumin and restarting the Nicardipine gtt. --- Someone had mentioned giving albumin right off the bat before even touching the Milrinone. Would still love to hear peoples thoughts and opinions on the situation.

The other night, we had a patient who was post op day 2 following a CABG x3. The patient had an ART line and SWAN. Upon starting shift, patient was on 0.125 of Milrinone. PAP was 50s/30s, CVP 24-26, SBP 140s. Cardiac Index was 2.2-2.7. Orders were to try to titrate Milrinone off and if CO/CI remained > 2.0 without milrinone, d/c SWAN. Well, patient's CI hovered steady at 2.6-2.7 for about an hour. I then turned off the milrinone to see what would happen. Now I know that milrinone has a rather long half-life, BUT, the patients CI went from 2.7 to 1.6 within an hour. PA pressures still in the 50s/30s, CVP still mid 20s, SBP still 140s. After a bit over an hour and seeing that the CI was continually decreasing, I ran some calculations and saw the SVR was 1900s. So I restarted the milrinone, and ended up titrating it up to 0.375 (orders to titrate q1h by 0.125 to keep CI > 2.0). SBP was increasing to 160s. What would you have done in this situation. (I obviously called and talked to the MD - but curious to see what you all would have suggested doing).