title: Levosimendan Versus Dobutamine in Myocardial Injury Patients with Septic Shock: A Randomized Controlled Trial.
abstract: BACKGROUND We aimed to investigate the effect of levosimendan on biomarkers of myocardial injury and systemic hemodynamics in patients with septic shock. MATERIAL AND METHODS After achieving normovolemia and a mean arterial pressure of at least 65 mmHg, 38 septic shock patients with low cardiac output (left ventricular ejective fraction), LEVF £45%) were randomly divided into two groups: levosimendan dobutamine. Patients in the levosimendan and dobutamine groups were maintained with intravenous infusion of levosimendan (0.2 μg/kg/minute) and dobutamine (5 μg/kg/minute) for 24 hours respectively. During treatment we monitored hemodynamics and LVEF, and measured levels of heart-type fatty acid binding protein (HFABP), troponin I (TNI), and brain natriuretic peptide(BNP). In addition, the length of mechanical ventilation, intensive care unit (ICU) stay, hospital stay, and 28-day mortality were compared between the two groups. RESULTS The levosimendan group and the dobutamine group were well matched with respect to age (years, 55.4 ± 1 7.5 versus 50.2 ± 13.6) and gender (males, 68.4% versus 57.9%). Levosimendan-treated patients had higher stroke volume index (SVI), cardiac index (CI), LVEF, and left ventricular stroke work index (LVSWI), and lower extravascular lung water index (EVLWI) compared to dobutamine-treated patients (p<0.05). HFABP, TNI, and BNP in the levosimendan group were less than in the dobutamine group (p<0.05). There was no difference in the mechanical ventilation time, length of stay in ICU and hospital, and 28-day mortality between the two groups. CONCLUSIONS Compared with dobutamine, levosimendan reduces biomarkers of myocardial injury and improves systemic hemodynamics in patients with septic shock. However, it does not reduce the days on mechanical ventilation, length of stay in ICU and hospital, or 28-day mortality.
authors.affiliation: Department of Intensive Care Unit, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China (mainland).
authors.forename: Jianb-biao
authors.initials: JB
authors.lastname: Meng
authors.affiliation: Department of Intensive Care Unit, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China (mainland).
authors.forename: Ma-hong
authors.initials: MH
authors.lastname: Hu
authors.affiliation: Department of Intensive Care Unit, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China (mainland).
authors.forename: Zhi-zhen
authors.initials: ZZ
authors.lastname: Lai
authors.affiliation: Department of Intensive Care Unit, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China (mainland).
authors.forename: Chun-lian
authors.initials: CL
authors.lastname: Ji
authors.affiliation: Department of Intensive Care Unit, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China (mainland).
authors.forename: Xiu-juan
authors.initials: XJ
authors.lastname: Xu
authors.affiliation: Department of Intensive Care Unit, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China (mainland).
authors.forename: Geng
authors.initials: G
authors.lastname: Zhang
authors.affiliation: Department of Ultrasonography, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China (mainland).
authors.forename: Shuyuan
authors.initials: S
authors.lastname: Tian
mesh_terms: D015415:Biomarkers / Q000097:blood; D003710:Demography; D004280:Dobutamine / Q000494:pharmacology / Q000627:therapeutic use*; D050556:Fatty Acid-Binding Proteins / Q000097:blood; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006835:Hydrazones / Q000494:pharmacology / Q000627:therapeutic use*; D019344:Lactic Acid / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009206:Myocardium / Q000473:pathology*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011724:Pyridazines / Q000494:pharmacology / Q000627:therapeutic use*; D012044:Regression Analysis; D012772:Shock, Septic / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D000077464:Simendan; D019210:Troponin I / Q000097:blood; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D050556:Fatty Acid-Binding Proteins; D006835:Hydrazones; D011724:Pyridazines; D019210:Troponin I; D020097:Natriuretic Peptide, Brain; D019344:Lactic Acid; D000077464:Simendan; D004280:Dobutamine