Children with congenital heart disease have significant morbidity including low cardiac
output syndrome and subsequent organ dysfunction that may be prevented by optimization of
circulatory function. More than half of these children receive milrinone. Clinical evaluation
cannot distinguish between patients with sub-therapeutic, therapeutic, and toxic milrinone
drug levels. Consequently children who require pharmacologic circulatory support may be
receiving sub-optimal dosing, and children who do not need milrinone may be receiving
milrinone unnecessarily. The primary objective of this study is to determine if optimizing
milrinone levels with therapeutic drug monitoring in critically ill children following
cardiac surgery improves clinical outcomes and reduces the duration of milrinone infusion.
This study hypothesizes that optimizing milrinone levels with therapeutic drug monitoring in
critically ill children following cardiac surgery will improve clinical outcomes and reduce
the duration of milrinone infusion.