Article

Hemodynamic effects of a continuous infusion of levosimendan in critically ill patients with cardiogenic shock requiring catecholamines.

Department of Cardiology, University of Vienna, Vienna, Austria.
Acta Anaesthesiologica Scandinavica (impact factor: 2.19). 12/2003; 47(10):1251-6. pp.1251-6
Source: PubMed

ABSTRACT 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.
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.
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.
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.

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Keywords

24-h hemodynamic effects
 
add-on therapy
 
arterial blood pressure
 
catecholamine therapy
 
catecholamines
 
continuous infusion
 
decompensated heart failure
 
diastolic blood pressure
 
hemodynamic function
 
Hemodynamic measurements
 
hemodynamics
 
ill patients
 
levosimendan infusion
 
LS infusion
 
novel inodilator
 
present series
 
Swan-Ganz thermodilution catheter
 
systemic vascular resistance
 
unchanged preload conditions
 
ventricular stroke work index