Role of levosimendan in sepsis and septic shock.
OBJECTIVE
To present the pharmacologic and biologic profile of levosimendan and discuss potential indications in the treatment of sepsis and septic shock, with a special focus on myocardial and pulmonary dysfunction.


RESULTS
In animal models of endotoxic shock, levosimendan improved both left ventricular systolic and diastolic dysfunction, as well as ventriculovascular coupling. In addition, positive effects have been reported on right ventricular performance and pulmonary circulation. Two randomized, controlled trials in patients with septic shock revealed levosimendan provided consistent beneficial effects on cardiopulmonary performance, global oxygen transport, splanchnic perfusion and renal function. These effects have been reported as superior to placebo and the classic inotropic agent dobutamine. Due to its vasodilatory effects, combination with vasoconstrictor agents may be crucial in the presence of arterial hypotension.


CONCLUSIONS
There is increasing evidence that levosimendan exerts beneficial effects in the treatment of sepsis-induced myocardial and pulmonary dysfunction. Future large-scale multicenter clinical trials are now needed to clarify whether levosimendan improves the overall outcome of patients with sepsis and septic shock.
Pinto
Bernardo Bollen
BB
Department of Anesthesiology and Intensive Care, University Hospital of Muenster, Muenster, Germany. bollenpinto@gmail.com
Rehberg
Sebastian
S
Ertmer
Christian
C
Westphal
Martin
M
D000818:Animals; D002118:Calcium / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D019446:Endotoxemia / Q000188:drug therapy; D006333:Heart Failure / Q000188:drug therapy; D006801:Humans; D006835:Hydrazones / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D015221:Potassium Channels / Q000187:drug effects; D011724:Pyridazines / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D018805:Sepsis / Q000188:drug therapy*; D012772:Shock, Septic / Q000188:drug therapy*; D000077464:Simendan
D006835:Hydrazones; D015221:Potassium Channels; D011724:Pyridazines; D000077464:Simendan; D002118:Calcium