title: Effects of levosimendan on right ventricular afterload in patients with acute respiratory distress syndrome: a pilot study.
abstract: OBJECTIVE
  Acute respiratory distress syndrome (ARDS) is frequently associated with increased pulmonary vascular resistance and thus with systolic load of the right ventricle. We hypothesized that levosimendan, a new calcium sensitizer with potential pulmonary vasodilator properties, improves hemodynamics by unloading the right ventricle in patients with ARDS.
  
  
  METHODS
  Prospective, randomized, placebo-controlled, pilot study.
  
  
  METHODS
  Twenty-two-bed multidisciplinary intensive care unit of a university hospital.
  
  
  METHODS
  Thirty-five patients with ARDS in association with septic shock.
  
  
  METHODS
  Patients were randomly allocated to receive a 24-hr infusion of either levosimendan 0.2 microg/kg/min (n = 18) or placebo (n = 17). Data from right heart catheterization, cardiac magnetic resonance, arterial and mixed venous oxygen tensions and saturations, and carbon dioxide tensions were obtained before and 24 hrs after drug infusion.
  
  
  RESULTS
  At a mean arterial pressure between 70 and 80 mm Hg (sustained with norepinephrine infusion), levosimendan increased cardiac index (from 3.8 +/- 1.1 to 4.2 +/- 1.0 L/min/m) and decreased mean pulmonary artery pressure (from 29 +/- 3 to 25 +/- 3 mm Hg) and pulmonary vascular resistance index (from 290 +/- 77 to 213 +/- 50 dynes/s/cm(5)/m(2); each p < .05). Levosimendan also decreased right ventricular end-systolic volume and increased right ventricular ejection fraction (p < .05). In addition, levosimendan increased mixed venous oxygen saturation (from 63 +/- 8 to 70 +/- 8%; p < .01).
  
  
  CONCLUSIONS
  This study provides evidence that levosimendan improves right ventricular performance through pulmonary vasodilator effects in septic patients with ARDS. A large multiple-center trial is needed to investigate whether levosimendan is able to improve the overall prognosis of patients with sepsis and ARDS.
authors.affiliation: Department of Anesthesiology and Intensive Care, University of Rome La Sapienza, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Morelli
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Teboul
authors.forename: Salvatore Maurizio
authors.initials: SM
authors.lastname: Maggiore
authors.forename: Antoine
authors.initials: A
authors.lastname: Vieillard-Baron
authors.forename: Monica
authors.initials: M
authors.lastname: Rocco
authors.forename: Giorgio
authors.initials: G
authors.lastname: Conti
authors.forename: Andrea
authors.initials: A
authors.lastname: De Gaetano
authors.forename: Umberto
authors.initials: U
authors.lastname: Picchini
authors.forename: Alessandra
authors.initials: A
authors.lastname: Orecchioni
authors.forename: Iacopo
authors.initials: I
authors.lastname: Carbone
authors.forename: Luigi
authors.initials: L
authors.lastname: Tritapepe
authors.forename: Paolo
authors.initials: P
authors.lastname: Pietropaoli
authors.forename: Martin
authors.initials: M
authors.lastname: Westphal
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D006976:Hypertension, Pulmonary / Q000188:drug therapy / Q000503:physiopathology; D007262:Infusions, Intravenous; D008297:Male; D010100:Oxygen / Q000097:blood; D010865:Pilot Projects; D011446:Prospective Studies; D011724:Pyridazines / Q000627:therapeutic use*; D012128:Respiratory Distress Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D012772:Shock, Septic / Q000188:drug therapy / Q000503:physiopathology; D000077464:Simendan; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology; D013599:Systole / Q000187:drug effects* / Q000502:physiology; D014655:Vascular Resistance / Q000187:drug effects / Q000502:physiology; D014665:Vasodilator Agents / Q000627:therapeutic use*; D018497:Ventricular Dysfunction, Right / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D006835:Hydrazones; D011724:Pyridazines; D014665:Vasodilator Agents; D000077464:Simendan; D010100:Oxygen