Document Detail


Hemodynamic effects of a continuous infusion of levosimendan in critically ill patients with cardiogenic shock requiring catecholamines.
MedLine Citation:
PMID:  14616323     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Levosimendan, a novel inodilator, has been shown to improve hemodynamic function in patients with decompensated heart failure with preserved arterial blood pressure. Data on its use in patients with cardiogenic shock are rare. The present series describes the 24-h hemodynamic effects of levosimendan as add-on therapy in desperately ill patients with cardiogenic shock requiring catecholamines. METHODS: Ten patients with cardiogenic shock received levosimendan as continuous infusion of 0.1 microg kg(-1) min(-1) for 24 h. The patients were otherwise unselected. Hemodynamic measurements were routinely performed at baseline (time 0) and at 1, 8, 16 and 24 h after start of levosimendan (LS) using a Swan-Ganz thermodilution catheter. RESULTS: During the levosimendan infusion there was a significant increase in cardiac index from 1.8 +/- 0.4 to 2.4 +/- 0.6 L*min-1*m-2 (P = 0.023) and a significant decrease in systemic vascular resistance from 1559 +/- 430 to 1109 +/- 202 dyn*s*cm-5 (P = 0.001), respectively. Changes in catecholamine dose, and in systolic and diastolic blood pressure were not significant. Given the individual response to LS, 8/10 patients showed an increase in left ventricular stroke work index under reduced or roughly unchanged preload conditions after 8 h. CONCLUSION: This series shows that a LS infusion is feasible and able to improve hemodynamics in severely compromized, critically ill patients with cardiogenic shock requiring catecholamine therapy. Its potential advantages when compared with other inotropes are unclear. To clarify the potential role of LS in this clinical setting randomized controlled trials on hemodynamic and mortality endpoints are needed.
Authors:
G Delle Karth; A Buberl; A Geppert; T Neunteufl; M Huelsmann; C Kopp; M Nikfardjam; R Berger; G Heinz
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Acta anaesthesiologica Scandinavica     Volume:  47     ISSN:  0001-5172     ISO Abbreviation:  Acta Anaesthesiol Scand     Publication Date:  2003 Nov 
Date Detail:
Created Date:  2003-11-17     Completed Date:  2004-04-01     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0370270     Medline TA:  Acta Anaesthesiol Scand     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  1251-6     Citation Subset:  IM    
Affiliation:
Department of Cardiology, University of Vienna, Vienna, Austria. georg.delle-karth@univie.ac.at
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MeSH Terms
Descriptor/Qualifier:
Aged
Blood Pressure / drug effects
Cardiac Output / drug effects
Cardiotonic Agents / administration & dosage*
Critical Illness
Dopamine / administration & dosage*
Drug Therapy, Combination
Hemodynamics / drug effects*
Humans
Hydrazones / administration & dosage*
Infusions, Intravenous
Pyridazines / administration & dosage*
Shock, Cardiogenic / drug therapy*,  physiopathology
Vasodilator Agents / administration & dosage*
Ventricular Function, Left / drug effects
Chemical
Reg. No./Substance:
0/Cardiotonic Agents; 0/Hydrazones; 0/Pyridazines; 0/Vasodilator Agents; 131741-08-7/simendan

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