Effects of Levosimendan on Right Ventricular Afterload in Patients with Acute Respiratory Distress Syndrome: a Pilot Study
(2006) In Critical Care Medicine 34(9). p.2287-2293- Abstract
- OBJECTIVE:
Acute respiratory distress syndrome (ARDS) is frequently associated with increased pulmonary vascular resistance and thus with systolic load of the right ventricle. We hypothesized that levosimendan, a new calcium sensitizer with potential pulmonary vasodilator properties, improves hemodynamics by unloading the right ventricle in patients with ARDS.
DESIGN:
Prospective, randomized, placebo-controlled, pilot study.
SETTING:
Twenty-two-bed multidisciplinary intensive care unit of a university hospital.
PATIENTS:
Thirty-five patients with ARDS in association with septic shock.
INTERVENTIONS:
Patients were... (More) - OBJECTIVE:
Acute respiratory distress syndrome (ARDS) is frequently associated with increased pulmonary vascular resistance and thus with systolic load of the right ventricle. We hypothesized that levosimendan, a new calcium sensitizer with potential pulmonary vasodilator properties, improves hemodynamics by unloading the right ventricle in patients with ARDS.
DESIGN:
Prospective, randomized, placebo-controlled, pilot study.
SETTING:
Twenty-two-bed multidisciplinary intensive care unit of a university hospital.
PATIENTS:
Thirty-five patients with ARDS in association with septic shock.
INTERVENTIONS:
Patients were randomly allocated to receive a 24-hr infusion of either levosimendan 0.2 microg/kg/min (n = 18) or placebo (n = 17). Data from right heart catheterization, cardiac magnetic resonance, arterial and mixed venous oxygen tensions and saturations, and carbon dioxide tensions were obtained before and 24 hrs after drug infusion.
MEASUREMENTS AND MAIN RESULTS:
At a mean arterial pressure between 70 and 80 mm Hg (sustained with norepinephrine infusion), levosimendan increased cardiac index (from 3.8 +/- 1.1 to 4.2 +/- 1.0 L/min/m) and decreased mean pulmonary artery pressure (from 29 +/- 3 to 25 +/- 3 mm Hg) and pulmonary vascular resistance index (from 290 +/- 77 to 213 +/- 50 dynes/s/cm(5)/m(2); each p < .05). Levosimendan also decreased right ventricular end-systolic volume and increased right ventricular ejection fraction (p < .05). In addition, levosimendan increased mixed venous oxygen saturation (from 63 +/- 8 to 70 +/- 8%; p < .01).
CONCLUSIONS:
This study provides evidence that levosimendan improves right ventricular performance through pulmonary vasodilator effects in septic patients with ARDS. A large multiple-center trial is needed to investigate whether levosimendan is able to improve the overall prognosis of patients with sepsis and ARDS. (Less)
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- author
- publishing date
- 2006
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Critical Care Medicine
- volume
- 34
- issue
- 9
- pages
- 2287 - 2293
- publisher
- Lippincott Williams & Wilkins
- external identifiers
-
- scopus:33747456675
- ISSN
- 1530-0293
- DOI
- 10.1097/01.CCM.0000230244.17174.4F
- language
- English
- LU publication?
- no
- id
- 2cd7d240-8eab-49d7-ad84-5e0a18077ed6 (old id 4216235)
- date added to LUP
- 2016-04-01 11:57:59
- date last changed
- 2022-04-13 03:57:53
@article{2cd7d240-8eab-49d7-ad84-5e0a18077ed6,
abstract = {{OBJECTIVE:<br/><br>
Acute respiratory distress syndrome (ARDS) is frequently associated with increased pulmonary vascular resistance and thus with systolic load of the right ventricle. We hypothesized that levosimendan, a new calcium sensitizer with potential pulmonary vasodilator properties, improves hemodynamics by unloading the right ventricle in patients with ARDS.<br/><br>
<br/><br>
DESIGN:<br/><br>
Prospective, randomized, placebo-controlled, pilot study.<br/><br>
<br/><br>
SETTING:<br/><br>
Twenty-two-bed multidisciplinary intensive care unit of a university hospital.<br/><br>
<br/><br>
PATIENTS:<br/><br>
Thirty-five patients with ARDS in association with septic shock.<br/><br>
<br/><br>
INTERVENTIONS:<br/><br>
Patients were randomly allocated to receive a 24-hr infusion of either levosimendan 0.2 microg/kg/min (n = 18) or placebo (n = 17). Data from right heart catheterization, cardiac magnetic resonance, arterial and mixed venous oxygen tensions and saturations, and carbon dioxide tensions were obtained before and 24 hrs after drug infusion.<br/><br>
<br/><br>
MEASUREMENTS AND MAIN RESULTS:<br/><br>
At a mean arterial pressure between 70 and 80 mm Hg (sustained with norepinephrine infusion), levosimendan increased cardiac index (from 3.8 +/- 1.1 to 4.2 +/- 1.0 L/min/m) and decreased mean pulmonary artery pressure (from 29 +/- 3 to 25 +/- 3 mm Hg) and pulmonary vascular resistance index (from 290 +/- 77 to 213 +/- 50 dynes/s/cm(5)/m(2); each p < .05). Levosimendan also decreased right ventricular end-systolic volume and increased right ventricular ejection fraction (p < .05). In addition, levosimendan increased mixed venous oxygen saturation (from 63 +/- 8 to 70 +/- 8%; p < .01).<br/><br>
<br/><br>
CONCLUSIONS:<br/><br>
This study provides evidence that levosimendan improves right ventricular performance through pulmonary vasodilator effects in septic patients with ARDS. A large multiple-center trial is needed to investigate whether levosimendan is able to improve the overall prognosis of patients with sepsis and ARDS.}},
author = {{Morelli, A and Teboul, JL and Maggiore, SM and Vieillard-Baron, A and Rocco, M and Conti, G and De Gaetano, A and Picchini, Umberto and Orecchioni, A and Carbone, I and Tritapepe, L and Pietropaoli, P and Westphal, M}},
issn = {{1530-0293}},
language = {{eng}},
number = {{9}},
pages = {{2287--2293}},
publisher = {{Lippincott Williams & Wilkins}},
series = {{Critical Care Medicine}},
title = {{Effects of Levosimendan on Right Ventricular Afterload in Patients with Acute Respiratory Distress Syndrome: a Pilot Study}},
url = {{http://dx.doi.org/10.1097/01.CCM.0000230244.17174.4F}},
doi = {{10.1097/01.CCM.0000230244.17174.4F}},
volume = {{34}},
year = {{2006}},
}