title: An efficacy and mechanism evaluation study of Levosimendan for the Prevention of Acute oRgan Dysfunction in Sepsis (LeoPARDS): protocol for a randomized controlled trial.
abstract: BACKGROUND
  Organ dysfunction consequent to infection ('severe sepsis') is the leading cause of admission to an intensive care unit (ICU). In both animal models and early clinical studies the calcium channel sensitizer levosimendan has been demonstrated to have potentially beneficial effects on organ function. The aims of the Levosimendan for the Prevention of Acute oRgan Dysfunction in Sepsis (LeoPARDS) trial are to identify whether a 24-hour infusion of levosimendan will improve organ dysfunction in adults who have septic shock and to establish the safety profile of levosimendan in this group of patients.
  
  
  METHODS
  This is a multicenter, randomized, double-blind, parallel group, placebo-controlled trial. Adults fulfilling the criteria for systemic inflammatory response syndrome due to infection, and requiring vasopressor therapy, will be eligible for inclusion in the trial. Within 24 hours of meeting these inclusion criteria, patients will be randomized in a 1:1 ratio stratified by the ICU to receive either levosimendan (0.05 to 0.2 μg.kg⁻¹.min⁻¹ or placebo for 24 hours in addition to standard care. The primary outcome measure is the mean Sequential Organ Failure Assessment (SOFA) score while in the ICU. Secondary outcomes include: central venous oxygen saturations and cardiac output; incidence and severity of renal failure using the Acute Kidney Injury Network criteria; duration of renal replacement therapy; serum bilirubin; time to liberation from mechanical ventilation; 28-day, hospital, 3 and 6 month survival; ICU and hospital length-of-stay; and days free from catecholamine therapy. Blood and urine samples will be collected on the day of inclusion, at 24 hours, and on days 4 and 6 post-inclusion for investigation of the mechanisms by which levosimendan might improve organ function. Eighty patients will have additional blood samples taken to measure levels of levosimendan and its active metabolites OR-1896 and OR-1855. A total of 516 patients will be recruited from approximately 25 ICUs in the United Kingdom.
  
  
  CONCLUSIONS
  This trial will test the efficacy of levosimendan to reduce acute organ dysfunction in adult patients who have septic shock and evaluate its biological mechanisms of action.
  
  
  BACKGROUND
  Current controlled trials ISRCTN12776039 (19 September 2013).
authors.forename: Robert M L'E
authors.initials: RM
authors.lastname: Orme
authors.forename: Gavin D
authors.initials: GD
authors.lastname: Perkins
authors.forename: Daniel F
authors.initials: DF
authors.lastname: McAuley
authors.forename: Kathleen D
authors.initials: KD
authors.lastname: Liu
authors.forename: Alexina J
authors.initials: AJ
authors.lastname: Mason
authors.forename: Andrea
authors.initials: A
authors.lastname: Morelli
authors.forename: Mervyn
authors.initials: M
authors.lastname: Singer
authors.forename: Deborah
authors.initials: D
authors.lastname: Ashby
authors.affiliation: Section of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK. anthony.gordon@imperial.ac.uk.
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Gordon
mesh_terms: D000328:Adult; D002302:Cardiac Output / Q000187:drug effects*; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics; D003422:Critical Care / Q000379:methods*; D003964:Diaphragm / Q000187:drug effects; D004311:Double-Blind Method; D005500:Follow-Up Studies; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics; D007668:Kidney / Q000187:drug effects; D009102:Multiple Organ Failure / Q000188:drug therapy* / Q000209:etiology; D011724:Pyridazines / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics; D012039:Regional Blood Flow / Q000187:drug effects; D012107:Research Design; D012772:Shock, Septic / Q000150:complications / Q000188:drug therapy*; D000077464:Simendan
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan