title: Beneficial effects of levosimendan in infants with sepsis-associated cardiac dysfunction: report of 2 cases.
abstract: Although international guidelines for hemodynamic support of pediatric septic shock suggest considering the potent calcium sensitizer inodilator levosimendan as a second-line inotropic agent to treat cold hypodynamic shock resistant to catecholamines, clinical experience in septic infants is lacking. We report the beneficial effects of levosimendan infusion in 2 infants (39 and 64 days old) with low cardiac output septic shock (ejection fraction, 29% and 33%; fractional shortening, 10% and 16% respectively) refractory to volume replacement and to the catecholamines dopamine and dobutamine. Levosimendan infusion (0.15 µg/kg/min) promptly increased both patients' myocardial contractility and improved tissue perfusion, thereby reducing lactate levels and increasing urine output. The only adverse effect was moderate hypotension in one infant, who reversed by adding norepinephrine to levosimendan. This clinical experience confirms the potential beneficial effects of levosimendan infusion to restore hemodynamics in infants with low cardiac output septic shock resistant to catecholamines.
authors.affiliation: Department of Pediatrics PICU, Sapienza University, Rome, Italy. p.papoff@libero.it
authors.forename: Paola
authors.initials: P
authors.lastname: Papoff
authors.forename: Elena
authors.initials: E
authors.lastname: Caresta
authors.forename: Paolo
authors.initials: P
authors.lastname: Versacci
authors.forename: Raffaella
authors.initials: R
authors.lastname: Pinto
authors.forename: Corrado
authors.initials: C
authors.lastname: Moretti
authors.forename: Fabio
authors.initials: F
authors.lastname: Midulla
mesh_terms: D002302:Cardiac Output / Q000187:drug effects* / Q000502:physiology; D002303:Cardiac Output, Low / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage / Q000627:therapeutic use*; D007223:Infant; D007262:Infusions, Intravenous; D008297:Male; D009200:Myocardial Contraction / Q000187:drug effects; D011724:Pyridazines / Q000008:administration & dosage / Q000627:therapeutic use*; D012772:Shock, Septic / Q000150:complications*; D000077464:Simendan
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan