title: Effects of levosimendan on systemic and regional hemodynamics in septic myocardial depression.
abstract: OBJECTIVE
  Calcium desensitization plays an important part in the pathophysiology of septic myocardial depression. We postulated that levosimendan, a new calcium sensitizer, would be beneficial in sepsis-induced cardiac dysfunction.
  
  
  METHODS
  Prospective, randomized, controlled study in two university hospital intensive care units.
  
  
  METHODS
  Twenty-eight patients with persisting left ventricular dysfunction related to septic shock after 48 h of conventional treatment including dobutamine (5 microg/kg per minute).
  
  
  METHODS
  After 48 h of conventional treatment patients were randomized to receive a 24-h infusion of either levosimendan (0.2 microg/kg per minute, n=15) or dobutamine (5 microg/kg per minute, n=13).
  
  
  RESULTS
  Data from right heart catheterization, echocardiography, gastric tonometry, laser-Doppler flowmetry, and lactate concentrations and creatinine clearance were obtained before and after the 24-h drug infusion. Dobutamine did not change systemic or regional hemodynamic variables. By contrast, at the same mean arterial pressure levosimendan decreased pulmonary artery occlusion pressure and increased cardiac index. Levosimendan decreased left ventricular end-diastolic volume and increased left ventricular ejection fraction. Levosimendan increased gastric mucosal flow, creatinine clearance, and urinary output while it decreased lactate concentrations.
  
  
  CONCLUSIONS
  These findings show that levosimendan improves systemic hemodynamics and regional perfusion in patients with septic cardiac dysfunction under conditions where administration of 5 microg/kg dobutamine per minute is no longer efficacious. Accordingly, our results suggest that levosimendan can be an alternative to the strategy of increasing the dose of dobutamine under such conditions.
authors.affiliation: Department of Anesthesiology and Intensive Care, University of Rome La Sapienza, Rome, Italy. andrea.morelli@uniroma1.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Morelli
authors.forename: Stefano
authors.initials: S
authors.lastname: De Castro
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Teboul
authors.forename: Mervyn
authors.initials: M
authors.lastname: Singer
authors.forename: Monica
authors.initials: M
authors.lastname: Rocco
authors.forename: Giorgio
authors.initials: G
authors.lastname: Conti
authors.forename: Leonardo
authors.initials: L
authors.lastname: De Luca
authors.forename: Emanuele
authors.initials: E
authors.lastname: Di Angelantonio
authors.forename: Alessandra
authors.initials: A
authors.lastname: Orecchioni
authors.forename: Natesa G
authors.initials: NG
authors.lastname: Pandian
authors.forename: Paolo
authors.initials: P
authors.lastname: Pietropaoli
mesh_terms: D002303:Cardiac Output, Low / Q000188:drug therapy*; D002316:Cardiotonic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D005753:Gastric Mucosa / Q000098:blood supply; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006835:Hydrazones / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011724:Pyridazines / Q000494:pharmacology / Q000627:therapeutic use*; D012772:Shock, Septic / Q000188:drug therapy*; D000077464:Simendan; D018709:Statistics, Nonparametric
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan